Information processing device, information processing method, and program

Abstract

To provide an information processing device, method and program that more accurately calculate medical expenses for each disease as to the disease described in a receipt.SOLUTION: An information processing device includes: a receipt information acquisition unit that acquires a plurality of pieces of receipt information relative to a specific patient, and prepared in a time sequence; an assignment identification unit that identifies an assignment of a medical practise or a medicine associated with the receipt information relative to diseases included in the receipt information; and a medical expenses calculation unit that on the basis of a score of the medical practise or medicine assigned to the disease. The assignment identification unit is configured to: distinguish a preferential disease of the disease included in second receipt information prepared after first receipt information on the basis of information on the disease included in the first receipt information of the plurality of pieces of receipt information; and identify the assignment of the medical practise or medicine relative to the disease included in the second receipt information, using a combination of the preferential disease, and the medical practise or medicine associated with the second receipt information.SELECTED DRAWING: Figure 1

Description

Technical Field

[0001] The present invention relates to an information processing apparatus, an information processing method, and a program for allocating medical expenses.

Background Art

[0002] Conventionally, a technique for calculating medical expenses for injuries and illnesses described on a receipt using the descriptions of medical treatments and pharmaceuticals described on the receipt has been known (Patent Document 1). A receipt is a bill of particulars created by a medical institution that has provided insured medical treatment for each insured person at the end of each month for outpatient and inpatient services separately based on a medical fee point table or the like. Multiple injury and illness names may be described on a receipt. For this reason, in Patent Document 1, for medical treatments and pharmaceuticals provided for multiple injury and illness names described on a receipt, a technique for identifying which injury or illness they correspond to using the information on pharmaceuticals and medical treatments described on the same receipt is proposed. By such a technique, it is possible to calculate medical expenses for an injury or illness (allocate medical expenses to an injury or illness) from the medical expenses described in association with a medical treatment or a pharmaceutical. Further, by using a database in which medical records of all subscribers are accumulated in chronological order for each insurer, it becomes possible to statistically analyze medical expenses from various viewpoints such as the insured person, the medical institution, and each injury or illness.

Prior Art Documents

Patent Documents

[0003]

Patent Document 1

Summary of the Invention

Problems to be Solved by the Invention

[0004] By the way, medical treatment for patients and provision of pharmaceuticals are continuously carried out, or several medical treatments and pharmaceuticals may be provided after follow-up observation. Therefore, by considering the information of receipts in a time series relationship, it is expected to identify medical treatments and pharmaceuticals for multiple injuries and illnesses described in the receipt and improve the accuracy of calculating medical expenses.

[0005] In Patent Document 1, a technique is proposed that uses information on pharmaceuticals and medical treatments described in the same receipt, and various master data for tracing the relationship between medical treatments and pharmaceuticals for the name of the injury or illness. However, it did not consider using information from other receipts in a time series relationship.

[0006] The present invention has been made in view of the above problems, and an object thereof is to realize a technique capable of more accurately calculating medical expenses for each injury or illness regarding the injuries or illnesses described in the receipt.

Means for Solving the Problems

[0007] To solve this problem, for example, the program of the present invention has the following configuration. That is, A computer program for causing a computer to function as each means of an information processing device, wherein the information processing device An acquisition means for acquiring a plurality of receipt information for a specific patient, the plurality of receipt information being created in a time series, A specifying means for specifying an assignment of a medical treatment or a pharmaceutical associated with the receipt information for an injury or illness included in the receipt information, A calculation means for calculating the medical expenses for the injury or illness based on the points of the medical treatment or the pharmaceutical assigned to the injury or illness, and having The specifying means identifies a priority injury or illness among the injuries or illnesses included in the second receipt information generated after the first receipt information based on the information of the injury or illness included in the first receipt information among the plurality of receipt information, and uses the combination of the priority injury or illness and the medical treatment or the pharmaceutical associated with the second receipt information to specify the assignment of the medical treatment or the pharmaceutical for the injury or illness included in the second receipt information.

Effect of the Invention

[0008] According to the present invention, it becomes possible to calculate the medical expenses for each injury or illness with higher accuracy for the injuries or illnesses described in the receipt.

Brief Description of the Drawings

[0009]

Figure 1

Figure 2

Figure 3A

Figure 3B

Figure 4A

Figure 4B

Figure 4C

Figure 4D

Figure 5

Figure 6A

Figure 6B

Figure 7

Figure 8

Mode for Carrying Out the Invention

[0010] Hereinafter, embodiments will be described in detail with reference to the accompanying drawings. Note that the following embodiments do not limit the invention according to the claims, and not all combinations of the features described in the embodiments are essential for the invention. Two or more of the features described in the embodiments may be arbitrarily combined. Also, the same or similar configurations are assigned the same reference numerals, and duplicate descriptions are omitted.

[0011] (Configuration of Information Processing Server) A functional configuration example of the information processing server 100 will be described with reference to FIG. 1. Note that each of the functional blocks to be described may be integrated or separated, and the functions to be described may be realized by other blocks. Also, what is described as hardware may be realized by software, and vice versa.

[0012] The communication unit 101 includes a communication circuit that communicates with various devices via a network. The communication unit 101 receives, for example, receipt information from information processing devices of various medical institutions. The power supply unit 102 includes a power supply that provides power necessary for the operation of the information processing server 100.

[0013] The storage unit 103 includes a non-volatile storage medium such as a hard disk or a semiconductor memory, and includes various programs executed by the control unit 104 of the information processing server 100, various data used by the control unit 104, and a DB. The various programs include, in addition to the program for executing the medical expense calculation process according to the present embodiment, an operating system, a framework, a library, and the like. The various data include, for example, setting values of the information processing server 100. The DB includes tables used for the medical expense calculation process such as a drug master, a drug table, an indication disease name link table, an indication disease name information file, which will be described later, and time-series receipt information.

[0014] The control unit 104 includes a CPU 110 which is a central processing unit and a RAM 111. By expanding and executing the program stored in the storage unit 103 in the RAM 111, the control unit 104 controls the operations of each part inside the control unit 104 and the operations of each part of the information processing server 100. Further, the control unit 104 executes the medical expense calculation process described later.

[0015] The receipt information acquisition unit 112 acquires from the storage unit 103 a plurality of receipt information for a specific patient created in chronological order.

[0016] Here, the receipt will be described. A receipt (German: Rezept) is a statement of claim created monthly by a medical institution or dispensing pharmacy that has provided insured medical treatment to an insurer (such as a health insurance association, the National Health Insurance Association, seafarers' insurance, mutual aid association, national health insurance, etc.) for each patient, separately for outpatient, inpatient, etc., based on a medical fee points table, etc. In the case of medical and dental departments, it may be called a medical fee statement, and in the case of a dispensing pharmacy, it may be called a dispensing fee statement. The receipt describes what diagnoses, tests have been performed on the patient, what treatments have been carried out, and how much medicine has been prescribed.

[0017] Figure 2 schematically shows an example of a receipt (here, a medical fee statement). The receipt 200 is provided with respective columns such as the medical treatment date 201, insurance details 202, patient 203, medical institution 204, injury / illness 205, points 206, summary 207, and billing 208. In the column of the medical treatment date 201, the date of the medical treatment is described. In the column of the insurance details 202, for example, the insured number of the patient is described. In the column of the patient 203, for example, the name and date of birth of the patient are described. In the column of the medical institution 204, for example, the name of the medical institution, location, number of beds, department of medicine, etc. are described. In the column of the injury / illness 205, the name of the injury / illness of the patient is described. There may be cases where multiple names of injuries / illnesses are described. In addition, the start date of medical treatment, etc. are described. Also, in the column of the points 206, for each defined category (initial visit, follow-up visit, medication, injection, treatment, surgery / anesthesia, examination, imaging diagnosis, hospitalization, etc.), the details and quantity of the medical treatment act and pharmaceuticals according to the medical fee point table are described. In the column of the summary 207, the detailed content and quantity of the medical treatment act and pharmaceuticals, etc. are described. In the column of the billing 208, the total points of the medical treatment acts received by the patient at the medical institution are described.

[0018] For example, as shown in FIG. 3A, when patient 300 visits a medical institution, the medical institution 310 or pharmacy that provides medical services or pharmaceuticals creates a receipt. The information described in the receipt may be transmitted and received as receipt information 320, which is digital information. As described above, since the receipt is created monthly, the receipt information accumulates and forms a time series. In the example shown in FIG. 3, a schematic example of the receipt information forming a time series for each medical institution is shown, but it can be more detailedly classified and time-serialized. In information processing server 100, the receipt information is classified and time-serialized, for example, for each patient, each medical institution, each medical department, each type of receipt (in the case of a medical receipt, for example, a medical inpatient receipt, a medical outpatient receipt, a DPC receipt), or as a dispensing receipt. Note that the receipt to be time-serialized is not limited to FIG. 3 or this example, and may be classified by at least any one of the patient, medical institution, medical department, and receipt type. For example, the receipt information is sequentially transmitted from the medical institution 310 to the information processing server 100 and accumulated in the information processing server 100. In the present embodiment, for convenience, as in the example shown in FIG. 3A, the case where the information processing server 100 receives receipt information from each medical institution 310 will be described as an example. However, the information processing server 100 may be configured to first receive the receipt information received by the insurer's information processing device from the medical institution from the insurer's information processing device.

[0019] In the medical expense calculation process described later, the allocation specifying unit 113 specifies the allocation of medical services or pharmaceuticals associated with the receipt information for the injury or illness included in the receipt information. The allocation between the injury or illness and the medical service or pharmaceutical will be described later.

[0020] In the medical expense calculation process described later, the medical expense calculation unit 114 calculates the medical expense for the injury or illness based on the points of medical procedures and pharmaceuticals assigned to the injury or illness by the assignment identification unit 113. An example of calculating medical expenses will be described with reference to FIG. 3B. In the example of FIG. 3B, the medical procedures included in the receipt are in a state where they are assigned to the injury or illness. In this example, only medical procedures are cited as an example, but medical expenses can be calculated in the same way when both medical procedures and pharmaceuticals are assigned to an injury or illness, or when only pharmaceuticals are assigned to an injury or illness.

[0021] In the example of FIG. 3B(a), "revisit fee, addition for details issuance system, etc., outpatient management addition, nasal patency" and "revisit fee, addition for details issuance system, etc., outpatient management addition" are respectively assigned to the sleep disorder and the anxiety disorder, which are the injuries or illnesses included in a certain receipt. There are cases where a medical procedure is assigned to one injury or illness, such as "nasal patency", and there are also cases where the same medical procedure is assigned to multiple injuries or illnesses, such as "revisit fee".

[0022] Figure 3B(b) shows the medical expenses (and points) for each medical treatment. In this example, for instance, the follow-up consultation fee is 730 yen (73 points), and the nasal patency is 3,000 yen (300 points). The medical expenses for sleep disorder are the sum of the cost of nasal patency, the follow-up consultation fee, the apportioned cost of additional items such as the issuance system of medical certificates, and the medical expenses of the outpatient management addition. The apportionment of medical expenses is calculated, for example, by dividing the medical expenses of the medical treatment by the number of assigned injuries or illnesses. That is, the medical expenses for sleep disorder are 3,000 + (730 + 10 + 520) / 2 = 3,630 yen. Also, the medical expenses for anxiety disorder are (730 + 10 + 520) / 2 = 630 yen. Note that the calculation method of medical expenses is not limited to the method shown in Figure 3B, and other calculation methods may be used. For example, in the example shown in Figure 3, the medical expenses for each of sleep disorder and anxiety disorder are calculated by allocating half of the medical expenses of the follow-up consultation fee (730 / 2). However, the medical expenses for each injury or illness may be calculated by multiplying a coefficient calculated for each medical treatment for a specific injury or illness or a coefficient predetermined for each medical treatment. For example, the medical expenses for anxiety disorder may be calculated as 730 × α + 10 × β + 520 × γ, where α, β, and γ are coefficients calculated for the follow-up consultation fee, additional items such as the issuance system of medical certificates, and the outpatient management addition for anxiety disorder, respectively. The calculation method of these coefficients may be arbitrary, but for example, it may be calculated probabilistically, that is, according to the number of occurrences of medical treatments for injuries or illnesses in all or part of the collected receipt information.

[0023] The dispensing data processing unit 115 associates the information of the dispensing receipt with those medical receipts (medical inpatient, outpatient, DPC) that have medical treatment acts such as prescription fees. Note that the medical treatment acts such as prescription fees are, for example, medical treatment acts described with the first four digits of the medical treatment point quick reference table classification number being "F400". The dispensing data processing unit 115 associates the information of the dispensing receipt and the information of the medical receipt based on, for example, the correspondence relationship of information for identifying a medical institution (for example, unique ID, medical institution ID) and the date (for example, the prescription date of the dispensing receipt, the medical treatment month of the medical receipt, etc.). The dispensing data processing unit 115 filters the combination of the pharmaceuticals included in the dispensing receipt and the diseases of the medical receipt (with medical treatment acts such as prescription fees) by using the indication master, and selects the practically applicable combination between the diseases and the pharmaceuticals. Note that the filtering by the indication master will be described later. The dispensing data processing unit 115 keeps the diseases of the medical receipt (with prescription fee description) associated with the pharmaceuticals of the dispensing receipt, obtained as a result of the filtering by the indication master, in a distinguishable state (for example, setting a flag) in the storage unit 103. In this way, when performing the medical expense calculation process based on the information of the medical receipt, the pharmaceuticals of the dispensing receipt can be taken into account.

[0024] The receipt data recording unit 116 stores the information of the receipt received by the communication unit 101 in the storage unit 103. As described above, the receipt information is distinguished for each patient, each medical institution, each medical department, each type of receipt (in the case of a medical receipt, for example, a medical inpatient receipt, an outpatient medical receipt, a DPC receipt) or a dispensing receipt, and is serialized. Also, in response to the command operation of the administrator of the information processing server 100, various tables are generated and the information of the generated tables is stored in the storage unit 103.

[0025] (Example of Medical Expense Calculation Process) Next, an example of the medical expense calculation process executed by the allocation specifying unit 113 and the medical expense calculation unit 114 will be described with reference to FIGS. 4A to 4D.

[0026] Figure 4A shows the processing when the time of the receipt information to be processed is t = 1 (the first receipt) among the receipt information constituting the time series. The receipt information 401 shown in Figure 4A includes injury / disease A, injury / disease B, and injury / disease C. In addition, medical treatment A, medical treatment B, and medical treatment C are associated with the receipt information 401.

[0027] Regarding filtering, which will be described later, in the example shown in Figure 4A, medical treatment A is a medical treatment that is not classified as an examination or surgery by the medical treatment point quick reference table classification number. Therefore, medical treatment A is a medical treatment not related to the implementation of the indication master. On the other hand, medical treatments B and C are medical treatments that can be selected by filtering using the indication master. However, medical treatment B is a medical treatment for which there is no combination shown in the indication master in relation to injury / diseases A to C, and medical treatment C is a medical treatment for which there is a combination shown in the indication master in relation to injury / disease C.

[0028] The allocation specifying unit 113 first generates combinations 402 of the assumed injuries / diseases and medical treatments by combining all of medical treatments A to C for each of injury / disease A, injury / disease B, and injury / disease C. The allocation specifying unit 113 selects the combinations shown in the indication master among the obtained combinations 402 by applying filtering using the indication master to the obtained combinations 402. Here, the indication master shows the predetermined practical combinations of injuries / diseases and medical treatments (or pharmaceuticals) that can be included in the receipt information. That is, by applying filtering using the indication master, the practical combinations of injuries / diseases and medical treatments (or pharmaceuticals) can be extracted from among the combinations 402 of the assumed injuries / diseases and medical treatments. In this embodiment, the filtering by the indication master is applied to medical treatments classified as examinations or surgeries by the medical treatment point quick reference table classification number.

[0029] In the example of FIG. 4A, medical treatment A is selected for all of injuries A to C regardless of the implementation of the indication master. There is no combination shown in the indication master in relation to injuries A to C for medical treatment B. For this reason, medical treatment B is not included in the existing combination 404. On the other hand, medical treatment C is selected as the existing combination 404 because there is a combination shown in the indication master in the combination with injury C.

[0030] Next, the allocation specifying unit 113 specifies the previous receipt information (405). The previous receipt information includes injuries (allocated injuries 406) including the medical treatment selected by the indication master among the injuries included in the combination 404, the medical treatments combined with each injury in the combination 404, and the medical treatments not allocated in the combination 404 (unallocated medical treatments 407). Further, the previous receipt information may include the identification number of the receipt that was the processing target and information on all medical treatments associated with the receipt.

[0031] Furthermore, the allocation specifying unit 113 allocates unallocated medical treatments (medical treatment B in the example of FIG. 4A) to each injury included in the existing combination 404 (408). By doing so, the medical expenses of the medical treatments that could not be explicitly allocated to a specific injury can be allocated to each injury. Thereafter, the medical expense calculation unit 114 calculates the medical expenses for each injury based on the combination to which the unallocated medical treatment is allocated by the process described above with reference to FIG. 3B.

[0032] (Medical expense calculation process for the receipt information at time t = 2) Next, referring to FIG. 4B, the processing when the time of the receipt information to be processed among the receipt information constituting the time series is t = 2 (next receipt) will be described. In the example shown in FIG. 4B, the receipt information 411 includes injury / disease A, injury / disease C, and injury / disease D. The receipt information 411 is associated with medical act A, medical act B, and medical act D. Medical act A and medical act B are the same as those described above in FIG. 4A. That is, medical act A is a medical act selected regardless of the implementation of the indication master, and medical act B is a medical act for which there is no combination indicated by the indication master in relation to injury / disease A, C, and D. Medical act D is a medical act for which there is a combination indicated by the indication master in relation to injury / disease C. Also, injury / disease C is the assigned injury / disease described above in FIG. 4A and is the injury / disease (already assigned injury / disease 412) included in the receipt information 411. Injury / disease D is a new injury / disease (newly emerged injury / disease 413) among the injuries / diseases included in the receipt information 411 that is not included in the receipt information 401. Injury / disease C, which is an already assigned injury / disease, and injury / disease D, which is a newly emerged injury / disease, are identified as priority injuries / diseases that are treated preferentially over other injuries / diseases (e.g., injury / disease A). On the other hand, injury / disease A is a non-priority injury / disease among the injuries / diseases included in the receipt information 411.

[0033] The allocation specifying unit 113 first performs filtering on the priority injuries / diseases (injury / disease C, D), and then combines the medical acts that were not assigned to any injury / disease in the filtering of (1) for the non-priority injuries / diseases (injury / disease A), and performs filtering by the indication master on the combination.

[0034] First, (1) will be described in detail. The allocation identification unit 113 generates a combination 414 of medical treatment actions for newly emerged injuries / illnesses and previously allocated injuries / illnesses by combining medical treatment actions A, B, and D for injuries / illnesses C and D. Then, the allocation identification unit 113 applies filtering based on the indication master and the previous receipt information to the combination 414 (415). At this time, the allocation identification unit 113 applies different filtering processes to the medical treatment actions for newly emerged injuries / illnesses (e.g., injury / illness D) and the medical treatment actions for previously allocated injuries / illnesses (e.g., injury / illness C). The allocation identification unit 113 applies filtering by the indication master to the combination of medical treatment actions for newly emerged injuries / illnesses. In the example shown in FIG. 4B, since there is no combination indicated by the indication master for medical treatment action D in relation to injury / illness D, it does not remain. Also, medical treatment action A remains as a medical treatment action that remains regardless of the application of the indication master. Therefore, only medical treatment action A is selected by filtering for the newly emerged injury / illness D.

[0035] On the other hand, for the combination of medical treatment actions for the previously allocated injury / illness C, filtering using the previous receipt information and filtering by the indication master are applied to the corresponding medical treatment actions respectively. In the filtering using the previous receipt information, an injury / illness action is selected (left remaining) in which a medical treatment action that is not an application target of the indication master and a medical treatment action that is not an application target of the indication master among the previous receipt information match. That is, since the medical treatment action A combined with injury / illness C matches the medical treatment action A for injury / illness C in the previous receipt information, it remains after filtering. Also, medical treatment action D is a processing target by the indication master and corresponds to the combination indicated by the indication master, so it remains after filtering. In this way, medical treatment actions A and D are combined with injury / illness C, and medical treatment action A is combined with injury / illness D (416).

[0036] Thus, in this embodiment, newly emerged injuries / illnesses and already assigned injuries / illnesses are preferentially handled. As a result, injuries / illnesses assigned for medical treatment in the previous receipt or newly added injuries / illnesses in the current receipt information can be treated as highly important injuries / illnesses, and medical treatment can be appropriately assigned to these injuries / illnesses. Also, for medical treatments that are not applicable to the indication master (medical treatment A), for example, medical treatments including reexamination fees and outpatient management surcharges, these medical treatments can be limitedly assigned to highly important injuries / illnesses (such as injury / illness C) that are considered to have actually undergone the medical treatment. That is, by allocating medical treatment A to less important injury / illness A, etc., it is possible to prevent the dispersion of medical expenses and calculate the medical expenses more accurately. Note that in this embodiment, the case of using the receipt information at t = 1 and the receipt information next to the receipt information at t = 1 (i.e., t = 2) is described as an example, but this embodiment is not only applicable to adjacent receipt information in time series. The processing according to this embodiment may be applied to, for example, the receipt information at t = 1 and the receipt information within a predetermined period after t = 1 (e.g., t = 3). Also, this embodiment is not limited to the case of using only two receipt information in time series, and is also applicable to the case of using three or more receipt information. For example, the previous receipt information may be generated from each of the receipt information at t = 1 and the receipt information at t = 2, and injuries / illnesses that overlap between any of the previous receipt information and the receipt information at t = 3, or injuries / illnesses in the receipt information at t = 3 that do not overlap with any of the previous receipt information may be identified (as already assigned injuries / illnesses or newly emerged injuries / illnesses). Even in this way, specific injuries / illnesses can be preferentially handled (as newly emerged injuries / illnesses or already assigned injuries / illnesses) in the receipt information in time series.

[0037] Next, (2) will be described. The allocation identification unit 113 then combines medical procedures that were not assigned to any injury or illness in the filtering of (1) for injuries or illnesses that are not priority injuries or illnesses (injury or illness A). In the example of FIG. 4B, for injury or illness A, medical procedure B is combined. The allocation identification unit 113 performs filtering on the combination using the indication master. In the example shown in FIG. 4B, since medical procedure B is not a combination indicated by the indication master for injury or illness A, at this stage, medical procedure B is not assigned to injury or illness A.

[0038] Furthermore, in the same manner as in the case of t = 1, the allocation identification unit 113 stores the combination of the injury or illness and the medical procedure identified at the current stage in the storage unit 103 as the previous information. Also, the allocation identification unit 113 assigns all unassigned medical procedures included in the receipt information 411 to all injuries or illnesses. Through the above processing, the assignment of medical procedures for the injuries or illnesses included in the receipt information is specified. Thereafter, the medical expense calculation unit 114 calculates the medical expenses for injuries or illnesses A, C, and D.

[0039] (Example of applying previous receipt information to newly emerged injuries or illnesses) Next, with reference to FIG. 4C, a processing example when receipt information 421 different from the case of FIG. 4B is input at time t = 2 will be described. The example of FIG. 4C shows an example including a new medical procedure E to which the indication master is not applied compared to the case of FIG. 4B.

[0040] The processing content is the same as the processing described with reference to FIG. 4B, but the processing results are different when filtering the combination 424 of medical procedures for newly emerged injuries or illnesses, etc. using the previous receipt information. Specifically, after combining medical procedures A, B, and E for injury or illness C, which is an already assigned injury or illness 422, and injury or illness E, which is a newly emerged injury or illness 423, the newly emerged injury or illness is filtered using the indication master. At this time, medical procedure A and medical procedure E, which are not the filtering targets of the indication master, will remain.

[0041] On the other hand, for the assigned injury or illness C, filtering by the previous receipt information filter and the indication master is applied. Then, since the medical treatment E that is new at t = 2 does not exist in the previous receipt information, it does not remain in the combination after filtering. That is, the result of filtering by the indication master and the previous receipt information is the combination shown in 426 of FIG. 4C.

[0042] That is, in this medical expense calculation process, when a medical treatment (medical treatment not classified as an examination or surgery by the medical treatment point quick reference table classification number) to which the indication master is not applied newly appears in the receipt to be processed, the medical treatment can be assigned only to the newly emerged injury or illness. That is, by performing filtering by the previous receipt information for the assigned injury or illness, it is possible to appropriately calculate the medical expenses without assigning such medical treatment to the assigned injury or illness.

[0043] The assignment specifying unit 113 then performs the process described above with reference to FIG. 4B. For example, the assignment specifying unit 113 performs a selection process for other injuries or illnesses (for example, non-priority injury or illness A), specifies the previous receipt information, and assigns unassigned medical treatments (427). The medical expense calculation unit 114 calculates the medical expenses assigned to each injury or illness (428).

[0044] (Example of application of previous receipt information for assigned injury or illness) Furthermore, with reference to FIG. 4D, a processing example when receipt information 431 different from the cases of FIGS. 4B and 4C is input at time t = 2 will be described. The example of FIG. 4D shows an example in which the medical treatment F to which the indication master is not applied is included in the receipt information 431. It is assumed that the medical treatment F is included in the previous receipt information. Furthermore, the receipt information does not include newly emerged injuries or illnesses. In the example of FIG. 4D, in the previous receipt information, injury or illness A includes medical treatment A, and injury or illness F includes medical treatment A and medical treatment F.

[0045] The processing content is the same as the processing described with reference to FIG. 4B. In the example shown in FIG. 4D, injuries A and F become the already assigned injuries 432 and 433. Therefore, the assignment specifying unit 113 combines medical treatments A, B, and F for each of injuries A and F. For the combination 434 of medical treatments for this already assigned injury, the assignment specifying unit 113 applies filtering based on the previous receipt information. Note that in this example, since there is no medical treatment for which filtering by the indication master is applied, the process is omitted.

[0046] When filtering the combination 434 of medical treatments by the previous receipt information, medical treatment F cannot be assigned to injury A which does not include medical treatment F in the previous receipt information. On the other hand, medical treatment F is assigned to injury F which includes medical treatment F in the previous receipt information (436). The assignment specifying unit 113 then specifies the previous receipt information and assigns unassigned medical treatments (437), and the medical expense calculation unit 114 calculates the medical expenses assigned to each injury (438). In this way, by filtering with the previous receipt information, medical treatments can be assigned only to the injuries for which medical treatments were actually performed in the past, and medical expenses can be accurately allocated. Also, as is clear from the above example, in the medical expense calculation process according to the present embodiment, the combination of injuries and medical treatments selected for the receipt information at t = 2 can be made different according to the content of the previous receipt information. Therefore, even if the receipt information at t = 2 is the same, if the content of the previous receipt information (i.e., the past treatment history) is different, the assigned injuries are different. Thus, the medical expense calculation process according to the present embodiment can reflect medical treatments related to past treatments by new medical treatments, follow-up observations, etc.

[0047] (Assignment of Medicines to Injuries) In the above description, the case where only the act of injury / sickness is associated with the receipt information was described as an example. However, in addition to or instead of medical treatment acts, pharmaceuticals can be associated with the receipt. The assignment of pharmaceuticals for an injury / sickness can be performed in the same manner as the assignment of the above-described medical treatment acts, except when adding pharmaceutical-specific processing described later. For this reason, regarding the assignment of pharmaceuticals for an injury / sickness, the case of time t = 2 will be briefly described as an example.

[0048] FIG. 5 shows an example of a medical expense calculation process when a pharmaceutical is associated with a receipt. In the example shown in FIG. 5, the receipt information 511 includes injury / sickness A, injury / sickness C, and injury / sickness D. Further, medical treatment act A, medical treatment act B, and pharmaceutical Y are associated with the receipt information 511. Medical treatment act A and medical treatment act B are the same as those described above in FIG. 4A. That is, medical treatment act A is a medical treatment act selected regardless of the implementation of the indication master, and medical treatment act B is a medical treatment act for which there is no combination indicated by the indication master in relation to injury / sickness A, C, and D. Pharmaceutical Y is a medical treatment act for which there is a combination indicated by the indication master in relation to injury / sickness C. Further, injury / sickness C is the assigned injury / sickness described above in FIG. 4A and is the injury / sickness (already assigned injury / sickness 512) included in the receipt information 511. Injury / sickness D is a new injury / sickness (newly emerged injury / sickness 513) that is included in the receipt information 511 and was not included in the previous receipt information among the injuries / sicknesses included in the receipt information 511. Injury / sickness A is a non-priority injury / sickness among the injuries / sicknesses included in the receipt information 511.

[0049] The assignment specifying unit 113 first performs filtering (515) on priority injuries / sicknesses (injury / sickness C, D), and then combines medical treatment acts that were not assigned to any injury / sickness in the filtering of (1) for non-priority injuries / sicknesses (injury / sickness A), and performs filtering by the indication master on the combination (516).

[0050] First, for injuries / illnesses C and D, the allocation determination unit 113 generates a combination 514 of medical treatments A and B and medicine Y for the newly emerged injuries / illnesses and the medical treatments for the already allocated injuries / illnesses. Then, the allocation determination unit 113 applies filtering based on the indication master and the previous receipt information to the combination 514 (515). At this time, the allocation determination unit 113 applies filtering by the indication master to the combination of medical treatments for the newly emerged injuries / illnesses (for example, injury / illness D). In the example shown in FIG. 5, since there is no combination indicated by the indication master for medicine Y in relation to injury / illness D, it does not remain. Also, medical treatment A remains as a medical treatment that remains regardless of the application of the indication master. Therefore, only medical treatment A is selected by the filtering for the newly emerged injury / illness D.

[0051] On the other hand, for the combination of medical treatments for the already allocated injury / illness C, filtering using the previous receipt information and filtering by the indication master are applied to the corresponding medical treatments respectively. Medicine Y has filtering by the indication master applied and is allocated to injury / illness C. In this way, medical treatment A and medicine Y are combined for injury / illness C, and medical treatment A is combined for injury / illness D (516).

[0052] Regarding the filtering of pharmaceuticals, processing specific to pharmaceuticals may be performed. For example, first, for the combination of an injury / illness and a pharmaceutical, prior to the combination of the injury / illness and the medical treatment act, filtering is performed using the indication master and the previous receipt information. Then, for the combination of the injury / illness and the pharmaceutical remaining after the filtering, identify the injury / illness combined with a pharmaceutical related to anesthesia (for example, the ATC classification is N01) (for example, set an anesthesia flag). Next, when performing filtering on the combination of the injury / illness and the medical treatment act, for the injury / illness with the anesthesia flag set, assume that the applicable disease name of the combined medical treatment act is "during anesthesia" and apply the filtering by the indication master. By doing so, for an injury / illness that uses anesthesia during examination, medical treatment acts and pharmaceuticals can be more appropriately assigned. This process of assuming the applicable disease name of the medical treatment act as "during anesthesia" may be applied not only in the case of t = 2 but also in the case of t = 1.

[0053] Next, the allocation specifying unit 113 combines a medical treatment act (medical treatment act B) that was not assigned to any injury / illness in the above filtering with an injury / illness (injury / illness A) that is not a prioritized injury / illness. Further, the allocation specifying unit 113 performs filtering by the indication master on the combination (517). As described above with reference to FIG. 4B, at this stage, medical treatment act B is not assigned to injury / illness A. Further, the allocation specifying unit 113 stores the previous receipt information in the storage unit 103. Also, the allocation specifying unit 113 assigns all unassigned medical treatment acts included in the receipt information 511 to all injury / illnesses. Thereafter, the medical fee calculation unit 114 calculates the medical fees for injury / illnesses A, C, and D.

[0054] (A series of operations related to the medical fee calculation process) Next, with reference to the flowcharts shown in FIGS. 6A and 6B, a series of operations of the medical fee calculation process according to the present embodiment will be described. The medical fee calculation process is executed by the control unit 104 executing a program stored in the storage unit 103. In the following description, for convenience, the case of combining a medical treatment act and a pharmaceutical for an injury / illness will be described, but at least one of the medical treatment act and the pharmaceutical may be combined with the injury / illness.

[0055] In S601, the receipt information acquisition unit 112 sequentially acquires the receipt information configured in time series and stored in advance in the storage unit 103.

[0056] In S602, the control unit 104 determines whether the acquired receipt information is the first (t = 1) receipt information. If the receipt information to be processed is the first receipt information, the control unit 104 proceeds with the process to S603; otherwise, the process proceeds to S620 shown in FIG. 6B.

[0057] In S603, the control unit 104 determines whether there is one injury or illness included in the receipt information. If there is one injury or illness, the process proceeds to S610. On the other hand, if there is more than one injury or illness included in the receipt information, the process proceeds to S604. In S610, the allocation identification unit 113 allocates all medical treatment acts and pharmaceuticals to one injury or illness and proceeds with the process to S609.

[0058] In S604, the dispensing data processing unit 115 executes the linking process of the dispensing receipt. As described above, the dispensing data processing unit 115 links the information of the dispensing receipt with those medical receipts (medical inpatient, outpatient, DPC) that have medical treatment acts such as prescription fees. The dispensing data processing unit 115 links the information of the dispensing receipt and the information of the medical receipt, and filters the combination of the pharmaceuticals included in the dispensing receipt and the injuries or illnesses of the medical receipt (with medical treatment acts such as prescription fees) by the indication master. The dispensing data processing unit 115 makes the injuries or illnesses of the medical receipt (with prescription fee descriptions) associated with the pharmaceuticals of the dispensing receipt obtained as a result of the filtering by the indication master referable.

[0059] In S605 to S609, the allocation identification unit 113 or the medical expense calculation unit 114 executes a process of calculating the medical expenses for the injury or illness on the receipt in the case of t = 1, which was described above with reference to FIG. 4A. That is, the allocation identification unit 113 combines the medical treatment and the pharmaceuticals for each injury or illness included in the receipt information (S605). The allocation identification unit 113 applies the indication master to the combination of the medical treatment and the pharmaceuticals for the injury or illness, and selects a practical combination of the injury or illness and the medical treatment or the pharmaceuticals (S606).

[0060] Here, a processing example for obtaining the relationship between the injury or illness and the pharmaceuticals in the indication master will be described with reference to FIG. 7 when applying the indication master. First, the allocation identification unit 113 extracts the pharmaceutical code in the receipt, and identifies the ATC classification corresponding to the pharmaceutical code in the receipt from the corresponding pharmaceutical code in the pharmaceutical master 700. Next, the corresponding efficacy code is identified from the corresponding ATC classification in the pharmaceutical table 701. Then, the corresponding ICD sub-classification is obtained from the corresponding efficacy code in the indication disease name link table 702 and compared with the injury or illness name (ICD10 sub-classification) included in the receipt. Note that the pharmaceutical master 700 is a table including records such as the pharmaceutical code, the ATC classification, and the ATC classification name. The pharmaceutical table 701 is a table including the pharmaceutical name, the efficacy code, the ATC classification, and the like. Further, the indication disease name link table 702 is a table including the efficacy code, the target efficacy name, the ICD, and the like. In this way, one or more injury or illness names (ICD10 sub-classifications) associated with a specific pharmaceutical can be identified.

[0061] Also, a process for obtaining the relationship between the injury or illness in the indication master and the medical treatment related to the examination will be described with reference to FIG. 8. In the applicable disease name information file 800 shown in FIG. 8, the medical treatment point quick reference table classification code and the ICD10 sub-classification are associated. Therefore, the allocation identification unit 113 can identify the ICD10 sub-classification from the medical treatment point quick reference table classification code.

[0062] In addition, the allocation specifying unit 113 can obtain the relationship between the injury / illness in the indication master and the medical treatment related to the examination by using the table 801 showing the medical treatment of the surgery shown in FIG. 8. Since the table 801 also associates the medical treatment point quick reference table classification code with the ICD10 subclassification, the allocation specifying unit 113 can specify the ICD10 subclassification from the medical treatment point quick reference table classification code.

[0063] Return to the description of FIG. 6A. The allocation specifying unit 113 stores the previous receipt information obtained by the process of S606 in the storage unit 103 (S607), and allocates all unallocated medical treatments and unallocated pharmaceuticals to all injuries / illnesses (S608). Finally, the medical expense calculation unit 114 calculates the medical expense for the injury / illness by using the medical expenses (points) of the medical treatments and pharmaceuticals allocated to each injury / illness (S609). Here, when there is one injury / illness, the result obtained by the process of S610 by the allocation specifying unit 113 is stored in the storage unit 103 as the previous receipt information, and the medical expense calculation unit 114 calculates the medical expense for the injury / illness (S609).

[0064] In S611, the control unit 104 determines whether the receipt information to be processed is the final receipt. If it is not the final receipt, the process returns to S602 to perform the process of the next receipt.

[0065] Referring to FIG. 6B, the process for the next receipt information (t = 2) will be described. In S620, the control unit 104 determines whether there is one injury / illness included in the receipt information. If there is one injury / illness, the process proceeds to S630. On the other hand, if there is not one injury / illness included in the receipt information, the process proceeds to S621. In S630, the allocation specifying unit 113 allocates all medical treatments and pharmaceuticals to one injury / illness, and the process proceeds to S629.

[0066] In S621, the dispensing data processing unit 115 executes the linking process of the dispensing receipt in the same manner as S604.

[0067] In S622 to S628, the allocation identification unit 113 or the medical expense calculation unit 114 executes a process of calculating the medical expenses for the injury / disease on the receipt for the case of t = 2, as described above with reference to FIGS. 4B (to FIGS. 4D and 5). That is, the allocation identification unit 113 identifies the prioritized injuries / diseases (newly emerged injuries / diseases, already allocated injuries / diseases) included in the receipt information, and combines the medical treatment acts and pharmaceuticals for the identified injuries / diseases (S622). The allocation identification unit 113 applies filtering by the indication master and the previous receipt information to the combination of the medical treatment acts and pharmaceuticals for the prioritized injuries / diseases (S623), and selects a practical combination or an existing combination of the injury / disease and the medical treatment act or the pharmaceutical (S624). Further, the allocation identification unit 113 applies the indication master to the combination of the medical treatment acts and pharmaceuticals for the non-prioritized injuries / diseases, and selects a practical combination of the non-prioritized injury / disease and the medical treatment act or the pharmaceutical (S625). Further, the allocation identification unit 113 stores the previous receipt information obtained by the process of S625 in the storage unit 103 (S626), and allocates all unallocated medical treatment acts and unallocated pharmaceuticals to all the injuries / diseases (S627). Finally, the medical expense calculation unit 114 calculates the medical expenses for the injury / disease using the medical expenses (points) of the medical treatment acts and pharmaceuticals allocated to each injury / disease (S628). Here, when there is one injury / disease, the allocation identification unit 113 stores the result obtained by the process of S630 in the storage unit 103 as the previous receipt information, and the medical expense calculation unit 114 calculates the medical expenses for the injury / disease (S628).

[0068] The control unit 104 determines whether the receipt to be processed is the final receipt. If the receipt to be processed is not the final receipt, the process returns to S601 to process the next receipt information. On the other hand, if the receipt to be processed is the final receipt, this medical expense calculation process is terminated.

[0069] As described above, in the present embodiment, using the information of the receipts configured in time series, for the injuries and illnesses included in the receipt information, the medical treatment acts and the assignment of pharmaceuticals associated with the receipt are specified. At this time, based on the information of the injuries and illnesses included in the receipt information of t = 1 among the plurality of receipt information, the priority injuries and illnesses (newly emerged injuries and illnesses, already assigned injuries and illnesses) among the injuries and illnesses included in the receipt information after t = 1 (for example, t = 2) are identified. Then, using the combination of the priority injuries and illnesses and the medical treatment acts or pharmaceuticals associated with the receipt information of t = 2, the assignment of the medical treatment acts or pharmaceuticals for the injuries and illnesses included in the receipt information of t = 2 is specified. By doing so, it is possible to preferentially assign highly accurate injuries and illnesses to new injuries and illnesses and injuries and illnesses for which medical treatment has actually been performed in the past. That is, for the injuries and illnesses described in the receipt, it becomes possible to calculate the medical expenses for each injury and illness with higher accuracy.

[0070] The invention is not limited to the above-described embodiment, and various modifications and changes are possible within the scope of the gist of the invention.

Explanation of Reference Numerals

[0071] 100... Information processing server, 103... Storage unit, 104... Control unit, 112... Receipt information acquisition unit, 113... Assignment specification unit, 114... Medical expense calculation unit

Claims

1. A computer program for causing a computer to function as each means of an information processing apparatus, wherein the information processing apparatus includes: an acquisition means for acquiring a plurality of receipt information for a specific patient, the plurality of receipt information being created in chronological order; a specifying means for specifying an allocation of a medical treatment or a medicine associated with the receipt information for an injury or illness included in the receipt information; a calculation means for calculating a medical expense for the injury or illness based on the score of the medical treatment or medicine allocated to the injury or illness, and having: The specifying means identifies a prioritized injury or illness among the injuries or illnesses included in the second receipt information generated after the first receipt information, based on the information of the injury or illness included in the first receipt information among the plurality of receipt information, and uses a combination of the prioritized injury or illness and the medical treatment or medicine associated with the second receipt information to specify an allocation of a medical treatment or a medicine for the injury or illness included in the second receipt information. A program characterized by this.

2. The specifying means identifies a new injury or illness not included in the first receipt information among the injuries or illnesses included in the second receipt information as the prioritized injury or illness, and uses a combination of the new injury or illness and the medical treatment or medicine associated with the second receipt information to specify an allocation of a medical treatment or a medicine for the injury or illness included in the second receipt information. The program according to claim 1, characterized by this.

3. The specifying means identifies a previously-occurring predetermined injury or illness included in the allocation specified by the first receipt information among the injuries or illnesses included in the second receipt information as the prioritized injury or illness, and uses a combination of the previously-occurring predetermined injury or illness and the medical treatment or medicine associated with the second receipt information to specify an allocation of a medical treatment or a medicine for the injury or illness included in the second receipt information. The program according to claim 1 or 2, characterized by this.

4. The specifying means further identifies an injury or illness that is not the prioritized injury or illness among the injuries or illnesses included in the second receipt information, and uses a combination of a medical treatment or a medicine not allocated to the prioritized injury or illness among the medical treatments or medicines associated with the second receipt information and the injury or illness that is not the prioritized injury or illness to specify an allocation of a medical treatment or a medicine for the injury or illness included in the second receipt information. The program according to any one of claims 1 to 3, characterized by this.

5. The predetermined injuries or illnesses already mentioned are injuries or illnesses related to a combination selected as a combination indicated in the indication master among combinations of injuries or illnesses included in the first receipt information and medical treatment acts or pharmaceuticals associated with the first receipt information, and include the same injuries or illnesses as those included in the second receipt information. The indication master is a predetermined practical combination of injuries or illnesses that can be included in receipt information and medical treatment acts or pharmaceuticals. The program according to claim 3 is characterized by this.

6. When specifying the allocation of medical treatment acts or pharmaceuticals for the injuries or illnesses included in the second receipt information, the specifying means selects a combination indicated in the indication master among combinations of the identified injuries or illnesses and medical treatment acts or pharmaceuticals associated with the second receipt information. The indication master is a predetermined practical combination of injuries or illnesses that can be included in receipt information and medical treatment acts or pharmaceuticals. The program according to any one of claims 1 to 4 is characterized by this.

7. Among combinations of the identified injuries or illnesses and medical treatment acts or pharmaceuticals associated with the second receipt information, in addition to the combination indicated in the indication master, a combination of the identified injuries or illnesses and a predetermined medical treatment act is selected. The program according to claim 6 is characterized by this.

8. The predetermined medical treatment act is a medical treatment act that is not classified as an examination or surgery by the classification number of the quick reference table for medical treatment points. The program according to claim 7 is characterized by this.

9. The specifying means identifies a predetermined injury or illness already mentioned included in the allocation specified by the first receipt information among the injuries or illnesses included in the second receipt information, and from among combinations of the predetermined injury or illness already mentioned and medical treatment acts or pharmaceuticals associated with the second receipt information, selects a combination of the predetermined injury or illness already mentioned and the predetermined medical treatment act and a combination indicated in the indication master. The program according to claim 7 or 8 is characterized by this.

10. The program according to any one of claims 1 to 9 further includes linking means for linking injuries or illnesses included in receipt information with a record of a medical treatment act classified as a prescription fee or the like by the classification number of the quick reference table for medical treatment points and pharmaceuticals included in the receipt information of the dispensing receipt.

11. The program according to any one of claims 1 to 10, characterized in that the plurality of receipt information is stored in a storage means in a time series created for at least any one of a patient, a medical institution, a medical department, and a type of receipt.

12. An information processing method in which each step is executed by an information processing apparatus, an acquisition step of acquiring a plurality of receipt information for a specific patient, the plurality of receipt information being created in a time series; a specifying step of specifying an allocation of a medical treatment or a medicine associated with the receipt information for an injury or illness included in the receipt information; a calculation step of calculating a medical cost for the injury or illness based on the score of the medical treatment or medicine allocated to the injury or illness, wherein in the specifying step, based on the information on the injury or illness included in the first receipt information among the plurality of receipt information, a priority injury or illness among the injuries or illnesses included in the second receipt information generated after the first receipt information is identified, and using the combination of the priority injury or illness and the medical treatment or medicine associated with the second receipt information, the allocation of the medical treatment or medicine for the injury or illness included in the second receipt information is specified.

13. an acquisition means for acquiring a plurality of receipt information for a specific patient, the plurality of receipt information being created in a time series; a specifying means for specifying an allocation of a medical treatment or a medicine associated with the receipt information for an injury or illness included in the receipt information; a calculation means for calculating a medical cost for the injury or illness based on the score of the medical treatment or medicine allocated to the injury or illness, wherein the specifying means identifies a priority injury or illness among the injuries or illnesses included in the second receipt information generated after the first receipt information based on the information on the injury or illness included in the first receipt information among the plurality of receipt information, and uses the combination of the priority injury or illness and the medical treatment or medicine associated with the second receipt information to specify the allocation of the medical treatment or medicine for the injury or illness included in the second receipt information.

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