Information processing device, information processing method, and program

Abstract

To provide an information processing device with which, regarding diseases cited in a receipt, it is possible to calculate a medical expense for each disease with higher accuracy.SOLUTION: An information processing device comprises: acquisition means for acquiring a plurality of receipt information pieces for a specific patient and created in time series; specification means for specifying, for a disease included in receipt information, allocation of medical practice and medicine which are associated with the receipt information; and calculation means for calculating a medical expense for the disease on the basis of the medical practice and the number of pieces of medicine allocated to the disease. The specification means identifies, on the basis of disease information included in first receipt information among the plurality of receipt information pieces, a priority disease among the diseases included in second receipt information generated after the first receipt information, and specifies, using a combination of the priority disease with the medical practice or medicine associated with the second receipt information, the allocation of medical practice or medicine for a disease included in the second receipt information.SELECTED DRAWING: Figure 6B

Description

[Technical field]

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

[0002] Conventionally, a technology is known that calculates medical expenses for an injury or illness recorded on a receipt using the description of medical procedures and medicines recorded on the receipt (Patent Document 1). A receipt is a billing statement prepared by a medical institution that has performed insured medical treatment for an insurer at the end of each month for each patient, separately for outpatient and inpatient treatment, based on a medical fee schedule or the like. A receipt may have multiple injury or illness names recorded on it. For this reason, Patent Document 1 proposes a technology that identifies which injury or illness corresponds to a medical procedure or medicine provided for multiple injury or illness names recorded on a receipt, using information on medicines and medical procedures recorded on the same receipt as a clue. With this technology, it is possible to calculate medical expenses for an injury or illness from medical expenses recorded in association with medical procedures and medicines (allocate medical expenses to injury or illness). In addition, by using a database that accumulates medical records of all subscribers for each insurer in chronological order, it becomes possible to statistically analyze medical expenses from various perspectives, such as by insured person, medical institution, injury or illness, etc. [Prior art documents] [Patent documents]

[0003] [Patent Document 1] JP 2007-172187 A Summary of the Invention [Problem to be solved by the invention]

[0004] However, medical procedures and the provision of medicines to patients may be performed continuously, or several medical procedures and medicines may be provided after follow-up observation. Therefore, by considering the chronological relationship of medical receipt information, it is expected that the accuracy of identifying medical procedures and medicines for multiple injuries and illnesses listed on the receipt and the calculation of medical expenses will be improved.

[0005] Patent Document 1 proposes technology that uses information on medicines and medical procedures listed on the same prescription, as well as various master data for tracing the relationship between medical procedures and medicines and names of illnesses and injuries, but does not take into consideration the use of information from other prescriptions that are in a chronological relationship.

[0006] The present invention has been made in consideration of the above-mentioned problems, and its purpose is to realize technology that makes it possible to more accurately calculate medical expenses for each injury or illness listed on a receipt. [Means for solving the problem]

[0007] In order to solve this problem, for example, the program of the present invention has the following configuration. A computer program for causing a computer to function as each means of an information processing device, the information processing device comprising: An acquisition means for acquiring a plurality of pieces of receipt information for a specific patient, the plurality of pieces of receipt information being created in chronological order; A means for identifying an allocation of a medical procedure or a medicine associated with the medical receipt information for an injury or illness included in the medical receipt information; A calculation means for calculating medical expenses for an injury or illness based on the points of medical procedures or medicines assigned to the injury or illness, The identification means is information on injury or illness included in first receipt information among the plurality of receipt information. and information on the injury or illness included in the second receipt information generated after the first receipt information. Based on the previous Record number 2. Identifying a prioritized injury or illness among the injuries or illnesses included in the medical receipt information, and linking the prioritized injury or illness to the second medical receipt information. 1. Combination with medical procedures or medicines After identifying the above, by combining a second medical procedure or drug linked to the second receipt information different from the first medical procedure or drug with the injury or illness that is not the priority injury or illness,The method is characterized in that it identifies the allocation of medical treatment or medicine for the injury or illness contained in the second prescription information. Effect of the Invention

[0008] According to the present invention, it is possible to more accurately calculate medical expenses for each illness or injury listed on a medical receipt. [Brief description of the drawings]

[0009] [Figure 1] FIG. 2 is a block diagram showing an example of a functional configuration of an information processing server as an example of an information processing device according to an embodiment of the present invention. [Diagram 2] A diagram for explaining an example of a medical receipt (e.g., medical fee statement) [Figure 3A] A diagram that explains the time series of receipts [Figure 3B] A diagram explaining an example of how medical expenses are calculated when medical procedures are assigned to injuries and illnesses. [Figure 4A] FIG. 1 is a diagram for explaining an example of the operation of the medical expense calculation process according to the present invention. [Figure 4B] FIG. 2 is a diagram for explaining an example of the operation of the medical cost calculation process according to the present invention. [Figure 4C] FIG. 1 is a diagram for explaining an example of application of previous receipt information to a new injury or illness in the medical expense calculation process according to the present invention. [Figure 4D] FIG. 1 is a diagram for explaining an example of application of previous receipt information to an already assigned injury or illness in the medical expense calculation process according to the present invention. [Diagram 5] FIG. 13 is a diagram for explaining an example of the medical cost calculation process according to the present invention when drugs are included. [Figure 6A] A flowchart showing a series of operations in the medical cost calculation process according to the present invention (t=1). [Figure 6B] A flowchart showing a series of operations in the medical cost calculation process according to the present invention (t=2). [Figure 7] A diagram showing an example of data used to obtain the relationship between illnesses and medicines [Figure 8] A diagram showing an example of data used to obtain the relationship between injuries and illnesses and medical treatments DETAILED DESCRIPTION OF THE PREFERRED EMBODIMENTS

[0010] Hereinafter, the 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 features described in the embodiments are essential to the invention. Two or more features among the multiple features described in the embodiments may be arbitrarily combined. In addition, the same reference numbers are used for the same or similar configurations, and duplicated descriptions are omitted.

[0011] (Configuration of information processing server) An example of the functional configuration of the information processing server 100 will be described with reference to Fig. 1. Each of the functional blocks described may be integrated or separated, and the functions described may be realized by another block. 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, medical receipt information from information processing devices of various medical institutions. The power supply unit 102 includes a power supply that provides power required 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 semiconductor memory, and includes various programs executed by the control unit 104 of the information processing server 100, and various data and DBs used by the control unit 104. The various programs include an operating system, a framework, a library, and the like, in addition to a program for executing the medical expense calculation process according to this embodiment. The various data include, for example, setting values ​​of the information processing server 100. The DB includes tables used in the medical expense calculation process, such as a drug master, a drug table, an indication disease name link table, and an indication disease name information file, which will be described later, as well as chronological receipt information.

[0014] The control unit 104 includes a CPU 110, which is a central processing unit, and a RAM 111. The control unit 104 loads a program stored in the storage unit 103 into the RAM 111 and executes it to control the operation of each unit inside the control unit 104 and to control the operation of each unit of the information processing server 100. The control unit 104 also executes a medical expense calculation process, which will be described later.

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

[0016] Here, we will explain receipts. A receipt (German: Rezept) is a billing statement prepared by a medical institution or dispensing pharmacy that has provided insured medical treatment, based on a medical fee schedule, for each patient each month for outpatient, inpatient, etc., and for the insurer (health insurance association, national health insurance association, seamen's insurance, mutual aid association, national health insurance, etc.). In the case of medical and dental care, it is sometimes called a medical fee statement, and in the case of dispensing pharmacies, it is sometimes called a dispensing fee statement. The receipt states what diagnosis, tests, and treatment were performed on the patient, and how much medicine was prescribed.

[0017] FIG. 2 shows a schematic example of a medical receipt (a medical fee statement in this case). A medical receipt 200 has columns for, for example, a medical treatment date 201, insurance details 202, a patient 203, a medical institution 204, an injury or illness 205, points 206, a summary 207, and a claim 208. The medical treatment date 201 column lists the date of medical treatment. The insurance details 202 column lists, for example, the insurer number of the patient. The patient 203 column lists, for example, the name and date of birth of the patient. The medical institution 204 column lists, for example, the name of the medical institution, its location, the number of hospital beds, the medical department, and the like. The injury or illness 205 column lists the name of the patient's injury or illness. Multiple injury or illness names may be listed. In addition, the start date of medical treatment, etc. is listed. In addition, the points 206 column describes the contents of medical procedures and pharmaceuticals and their amounts according to the medical fee schedule for each defined category (initial consultation, follow-up consultation, medication, injection, procedure, surgery / anesthesia, examination, diagnostic imaging, hospitalization, etc.). The summary 207 column describes the detailed contents of medical procedures and pharmaceuticals and their amounts. The billing 208 column describes the total points for the medical procedures the patient received at the medical institution.

[0018] For example, as shown in FIG. 3A, when a patient 300 visits a medical institution, a medical institution 310 or a dispensing pharmacy that provides a medical procedure or medicine creates a medical receipt. Information written on the medical receipt may be transmitted and received as digital information 320. As described above, medical receipts are created monthly, and the medical receipt information is accumulated to form a time series. In the example shown in FIG. 3, a schematic example of a time series of medical receipt information for each medical institution is shown, but the time series may be divided in more detail. In the information processing server 100, the medical receipt information is classified and chronologically organized, for example, by patient, by medical institution, by medical department, by type of receipt (in the case of a medical receipt, for example, medical inpatient receipt, medical outpatient receipt, DPC receipt), or by dispensing receipt. Note that the receipts to be chronologically organized may be divided by at least one of the following, not limited to FIG. 3 or this example: patient, medical institution, medical department, and type of receipt. For example, the medical receipt information is sequentially transmitted from the medical institutions 310 to the information processing server 100 and stored in the information processing server 100. For convenience, in this embodiment, as in the example shown in Fig. 3A, a case will be described in which the information processing server 100 receives medical receipt information from each medical institution 310. However, the information processing server 100 may be configured to first receive, from the insurer's information processing device, the medical receipt information that the insurer's information processing device has received from the medical institution.

[0019] The allocation specification unit 113 specifies the allocation of medical procedures and medicines linked to the medical receipt information for the illness or injury included in the medical receipt information in the medical expense calculation process described later. The allocation of the illness or injury and the medical procedures or medicines will be described later.

[0020] The medical expenses calculation unit 114 calculates the medical expenses of an injury or illness based on the points of the medical procedure and medicine assigned to the injury or illness by the allocation specification unit 113 in a medical expenses calculation process described later. An example of medical expenses calculation will be described with reference to FIG. 3B. In the example of FIG. 3B, the medical procedure included in the receipt is assigned to the injury or illness. In this example, only the medical procedure is taken as an example, but medical expenses can be calculated in the same way when the medical procedure and medicine are assigned to the injury or illness, or when only medicine is assigned to the injury or illness.

[0021] In the example of Figure 3B(a), the illnesses included in a certain receipt, sleep disorder and anxiety disorder, are assigned "re-examination fee, statement issuance system surcharge, outpatient management surcharge, nasal airflow" and "re-examination fee, statement issuance system surcharge, outpatient management surcharge," respectively. In some cases, such as "nasal airflow," a medical procedure is assigned to one illness, and in other cases, such as "re-examination fee," the same medical procedure is assigned to multiple illnesses.

[0022] FIG. 3B(b) shows the medical expenses (and points) of each medical procedure. In this example, for example, the re-examination fee is 730 yen (73 points), and the nasal airflow rate is 3000 yen (300 points). The medical expenses for sleep disorders are the sum of the cost of the nasal airflow rate and the cost of the re-examination fee, the billing system surcharge, and the outpatient management surcharge, which are allocated to the medical expenses. The allocation of medical expenses is calculated, for example, by dividing the medical expenses of the medical procedure by the number of allocated injuries and illnesses. That is, the medical expenses for sleep disorders are 3000+(730+10+520) / 2=3630 yen. Also, the medical expenses for anxiety disorders are (730+10+520) / 2=630 yen. Note that the method of calculating medical expenses is not limited to the method shown in FIG. 3B, and other calculation methods may be used. For example, in the example shown in FIG. 3, the medical expenses for each of sleep disorders and anxiety disorders are calculated by allocating half (730 / 2) of the medical expenses for the medical procedure of the re-examination fee. However, the medical expenses for each injury or illness may be calculated by multiplying a coefficient calculated for each medical procedure for a specific injury or illness or a coefficient predetermined for each medical procedure. For example, the medical expenses for anxiety disorders may be calculated as 730×α+10×β+520×γ, where α, β, and γ may be coefficients calculated for the re-examination fee, the statement issuance system surcharge, and the outpatient management surcharge for anxiety disorders. The calculation method of these coefficients may be arbitrary, but for example, they may be calculated probabilistically, that is, according to the number of occurrences of medical procedures for injuries or illnesses in all or part of the collected receipt information.

[0023] The dispensing data processing unit 115 links the information of the dispensing receipt to those of the medical receipt (medical hospitalization, medical outpatient hospitalization, DPC) that include medical treatment such as prescription fees. Incidentally, the medical treatment such as prescription fees is, for example, a medical treatment in which the first four digits of the classification number of the medical fee quick reference table are described as "F400". The dispensing data processing unit 115 links the information of the dispensing receipt and the information of the medical receipt based on, for example, the correspondence relationship between the information identifying the medical institution (for example, a unique ID, a medical institution ID) and the date (for example, the prescription date of the dispensing receipt, the medical treatment date of the medical receipt, etc.). The dispensing data processing unit 115 filters the combination of the medicine included in the dispensing receipt and the injury / illness of the medical receipt (with medical treatment such as prescription fees) using the indication master, and selects a practical combination between the injury / illness and the medicine. Incidentally, filtering using the indication master will be described later. The dispensing data processing unit 115 stores the illnesses and injuries on medical receipts (which contain prescription fees) associated with the medicines on the dispensing receipts, obtained as a result of filtering using the indication master, in an identifiable state (for example, by setting a flag) in the storage unit 103. In this way, the medicines on the dispensing receipts can be taken into account when performing medical expense calculation processing based on the information on the medical receipts.

[0024] The receipt data recording unit 116 stores the receipt information received by the communication unit 101 in the memory unit 103. As described above, the receipt information is classified by patient, by medical institution, by medical department, by type of receipt (for example, in the case of medical receipts, medical inpatient receipt, medical outpatient receipt, DPC receipt) or as a dispensing receipt, and is organized in chronological order. In addition, in response to command operations by the administrator of the information processing server 100, various tables to be stored in the memory unit 103 are generated, and information on the generated tables is stored in the memory 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] Fig. 4A shows processing when the time of the receipt information to be processed is t=1 (first receipt) among receipt information constituting a time series. Receipt information 401 shown in Fig. 4A includes injury / illness A, injury / illness B, and injury / illness C. In addition, medical procedures A, B, and C are linked to receipt information 401.

[0027] Filtering will be described later, but in the example shown in FIG. 4A, medical procedure A is a medical procedure that is not classified as an examination or surgery by the classification number of the medical fee quick reference table. Therefore, medical procedure A is a medical procedure that is not related to the implementation of the indications master. On the other hand, medical procedures B and C are medical procedures that can be selected by filtering using the indications master. However, medical procedure B is a medical procedure for which there is no combination indicated by the indications master in relation to illnesses A to C, and medical procedure C is a medical procedure for which there is a combination indicated by the indications master in relation to illnesses C.

[0028] The allocation specification unit 113 first combines all medical procedures A to C with each of the injury / illness A, injury / illness B, and injury / illness C to generate a combination 402 of an expected injury / illness and medical procedure. The allocation specification unit 113 applies filtering using the indication master to the obtained combination 402, thereby selecting a combination indicated by the indication master from the obtained combination 402. Here, the indication master indicates a practical combination of an injury / illness and a medical procedure (or a medicine) that may be included in the medical receipt information. That is, by applying filtering using the indication master, a practical combination of an injury / illness and a medical procedure (or a medicine) can be extracted from the expected injury / illness and medical procedure combination 402. In this embodiment, filtering using the indication master is applied to a medical procedure classified as an examination or surgery by the classification number of the medical fee quick reference table.

[0029] In the example of FIG. 4A, medical procedure A is selected for all of illnesses A to C, regardless of the implementation of the indications master. For medical procedure B, there is no combination shown in the indications master in relation to illnesses A to C. For this reason, medical procedure B is not included in the actual combinations 404. On the other hand, for medical procedure C, there is a combination shown in the indications master in combination with illness C, so it is selected as an actual combination 404.

[0030] Next, the allocation specification unit 113 specifies previous receipt information (405). The previous receipt information includes, among the injuries and illnesses included in the combination 404, injuries and illnesses that include the medical procedure selected by the indication master (assigned injuries and illnesses 406), medical procedures combined with each injury or illness in the combination 404, and medical procedures not assigned in the combination 404 (unassigned medical procedures 407). Furthermore, the previous receipt information may include the identification number of the receipt that was the processing target, and information on all medical procedures linked to the receipt.

[0031] Furthermore, the allocation specification unit 113 allocates (408) an unallocated medical procedure (medical procedure B in the example of FIG. 4A) to each injury or illness included in the actual combination 404. In this way, the medical expenses of medical procedures that could not be explicitly allocated to a specific injury or illness can be allocated to each injury or illness. After that, the medical expenses calculation unit 114 calculates the medical expenses for each injury or illness based on the combination to which the unallocated medical procedures are allocated, by the process described above in FIG. 3B.

[0032] (Medical cost calculation process for receipt information at time t=2) Next, referring to FIG. 4B, a process will be described for the case where the time of the receipt information to be processed is t=2 (next receipt) among the receipt information constituting the time series. In the example shown in FIG. 4B, the receipt information 411 includes illness A, illness C, and illness D. Medical procedure A, medical procedure B, and medical procedure D are linked to the receipt information 411. Medical procedure A and medical procedure B are the same as those described above in FIG. 4A. That is, medical procedure A is a medical procedure that is selected regardless of the implementation of the indication master, and medical procedure B is a medical procedure for which there is no combination indicated by the indication master in relation to the illness A, C, and D. Medical procedure D is a medical procedure for which there is a combination indicated by the indication master in relation to the illness C. In addition, illness C is an already-assigned illness described above in FIG. 4A, and is an illness (already-assigned illness 412) included in the receipt information 411. Illness D is a new illness (new illness 413) that is not included in the medical receipt information 401 among the illnesses included in the medical receipt information 411. Illness C, which is an already assigned illness, and illness D, which is a new illness, are identified as priority illnesses that are given priority over other illnesses (e.g., illness A). On the other hand, illness A is a non-priority illness among the illnesses included in the medical receipt information 411.

[0033] The allocation identification unit 113 (1) first performs filtering on the prioritized injuries / illnesses (injuries / illnesses C and D), and then (2) for the non-priority injury / illness (injury / illness A), combines the medical procedures that were not assigned to any of the injuries / illnesses in the filtering of (1), and filters the combination using the indication master.

[0034] First, (1) will be described in detail. The allocation specification unit 113 combines medical procedures A, B, and D for illnesses C and D to generate a combination 414 of medical procedures for new illnesses and previously assigned illnesses. Then, the allocation specification unit 113 applies filtering by the indication master and previous receipt information to the combination 414. At this time, the allocation specification unit 113 applies different filter processing to medical procedures for new illnesses (e.g., illness D) and medical procedures for previously assigned illnesses (e.g., illness C). The allocation specification unit 113 applies filtering by the indication master to the combination of medical procedures for new illnesses. In the example shown in FIG. 4B, medical procedure D does not remain because there is no combination indicated by the indication master in relation to illness D. In addition, medical procedure A is a medical procedure that remains regardless of the application of the indication master. Therefore, only medical procedure A is selected by filtering for new illness D.

[0035] On the other hand, for combinations of medical procedures for illness C, which is an already assigned illness, filtering using the previous receipt information and filtering using the indication master are applied to the corresponding medical procedures. In filtering using the previous receipt information, medical procedures that are not subject to the indication master and medical procedures that are not subject to the indication master in the previous receipt information are selected (retained). In other words, medical procedure A combined with illness C matches medical procedure A for illness C in the previous receipt information, so it remains after filtering. In addition, medical procedure D is subject to processing by the indication master and corresponds to the combination indicated by the indication master, so it remains after filtering. In this way, medical procedures A and D are combined with illness C, and medical procedure A is combined with illness D (416).

[0036] In this manner, in this embodiment, new illnesses and illnesses that have already been assigned are given priority. As a result, illnesses to which medical procedures have been assigned in the previous receipt and illnesses newly added in the current receipt information can be treated as illnesses with high importance, and medical procedures can be appropriately assigned to these illnesses. In addition, medical procedures (medical procedures A) that are not subject to the indication master include, for example, medical procedures such as re-examination fees and outpatient management surcharges, and these medical procedures can be assigned exclusively to illnesses with high importance (such as illness C) for which medical procedures are considered to have actually been performed. In other words, by allocating medical procedures A to illnesses with low importance such as illness A, it is possible to prevent medical expenses from being dispersed and to calculate medical expenses more accurately. In this embodiment, the case where the receipt information of t=1 and the next receipt information of the receipt information of t=1 (i.e., t=2) are used will be described as an example, but this embodiment is not only applied to receipt information adjacent in time series. The processing according to this embodiment may be applied to, for example, the receipt information of t=1 and receipt information within a predetermined period after t=1 (e.g., t=3). In addition, this embodiment is not limited to the case where only two receipt information in time series are used, but can also be applied to the case where three or more receipt information are used. For example, previous receipt information may be generated from each of the receipt information of t=1 and the receipt information of t=2, and an injury or illness that overlaps between any of the previous receipt information and the receipt information of t=3, or an injury or illness of the receipt information of t=3 that does not overlap with any of the previous receipt information may be identified (as an already assigned injury or illness or a new injury or illness). In this way, specific illnesses (as new illnesses or already assigned illnesses) can be given priority in the chronological prescription information.

[0037] Next, (2) will be described. The allocation specification unit 113 then combines a medical procedure that was not assigned to any illness in the filtering of (1) with an illness that is not a priority illness (illness A). In the example of Fig. 4B, medical procedure B is combined with illness A. The allocation specification unit 113 performs filtering on the combination using the indications master. In the example shown in Fig. 4B, medical procedure B is not a combination indicated by the indications master for illness A, so at this stage, medical procedure B is not assigned to illness A.

[0038] Furthermore, the allocation specification unit 113 stores the combination of the injury / illness and medical procedure identified at the current stage as previous information in the memory unit 103, as in the case of t=1. The allocation specification unit 113 also assigns unassigned medical procedures included in the receipt information 411 to all injuries / illnesses. Through the above process, the allocation of medical procedures to injuries / illnesses included in the receipt information is specified. Thereafter, the medical cost calculation unit 114 calculates the medical costs for injuries / illnesses A, C, and D.

[0039] (Example of applying previous receipt information to a new injury or illness) Next, referring to Fig. 4C, a processing example will be described in which receipt information 421 different from that in Fig. 4B is input at time t = 2. The example in Fig. 4C shows an example in which receipt information 421 includes a new medical procedure E to which the indication master is not applied, as compared to the case in Fig. 4B.

[0040] The processing contents are the same as the processing described with reference to Fig. 4B, but the processing result when filtering by previous receipt information is applied to combination of medical procedures for new illnesses and injuries 424 is different. Specifically, after combining medical procedures A, B, and E with illness C, which is an already assigned illness and injury 422, and illness E, which is a new illness and injury 423, filtering is applied to the new illness and injury using the indications master. At this time, medical procedures A and E, which are not subject to filtering using the indications master, remain.

[0041] On the other hand, for illness C, which is an already assigned illness, filtering based on the previous receipt information and the indication master is applied. Then, medical procedure E, which is new at t=2, does not exist in the previous receipt information, so it does not remain in the combination after filtering. In other words, the result of filtering based on the indication master and previous receipt information is the combination shown in 426 in Figure 4C.

[0042] In other words, in this medical cost calculation process, when a medical procedure not applicable to the indication master (a medical procedure not classified as an examination or surgery by the medical fee quick reference table classification number) appears for the first time on the receipt to be processed, the medical procedure can be assigned only to the new injury or illness. In other words, by filtering already assigned injuries or illnesses using previous receipt information, it becomes possible to not assign such a medical procedure to already assigned injuries or illnesses, and to calculate medical expenses appropriately.

[0043] The allocation specifying unit 113 then performs the process described above in Fig. 4B. For example, the allocation specifying unit 113 executes a selection process for other illnesses (e.g., illness A that is not a priority), a determination of previous receipt information, and an allocation of unallocated medical procedures (427). The medical cost calculation unit 114 calculates the medical costs allocated to each illness (428).

[0044] (Example of application of previous receipt information to already allocated illnesses) Furthermore, referring to Fig. 4D, a processing example will be described in which receipt information 431 different from that in Figs. 4B and 4C is input at time t=2. The example in Fig. 4D shows an example in which medical procedure F, to which the indication master is not applied, is included in receipt information 431. It is assumed that medical procedure F is included in the previous receipt information. Furthermore, the receipt information does not include any newly discovered illnesses or injuries. In the example in Fig. 4D, in the previous receipt information, illness A includes medical procedure A, and illness F includes medical procedure A and medical procedure F.

[0045] The processing content is the same as the processing described with reference to Fig. 4B. In the example shown in Fig. 4D, illness A and illness F are already assigned illnesses 432 and 433. Therefore, the allocation specification unit 113 combines medical procedures A, B, and F with illness A and illness F, respectively. The allocation specification unit 113 applies filtering based on previous receipt information to this combination of medical procedures for already assigned illnesses 434. Note that in this example, there is no medical procedure to which filtering based on indication master is applied, so the processing is omitted.

[0046] When filtering is performed on the combination of medical procedures 434 based on the previous receipt information, the medical procedure F is not assigned to the injury or illness A whose previous receipt information does not include the medical procedure F. On the other hand, the medical procedure F is assigned to the injury or illness F whose previous receipt information includes the medical procedure F (436). The allocation specification unit 113 then specifies the previous receipt information and assigns the unassigned medical procedures (437), and the medical cost calculation unit 114 calculates the medical costs assigned to each injury or illness (438). In this way, by filtering based on the previous receipt information, the medical procedure can be assigned only to the injury or illness for which a medical procedure was actually performed in the past, and the medical cost can be accurately allocated. Also, as is clear from the above example, in the medical cost calculation process according to this embodiment, the combination of injury or illness and medical procedure selected for the receipt information at t=2 can be changed depending on 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 medical history) is different, the injury or illness to be assigned will be different. In this manner, the medical expense calculation process according to this embodiment can reflect new medical procedures and medical procedures related to past treatments due to follow-up observations and the like.

[0047] (Allocation of medicines for injuries and illnesses) In the above explanation, an example was given of a case where only illness or injury actions are linked to medical receipt information. However, medicines can be linked to medical receipts in addition to or instead of medical treatment actions. Allocation of medicines to illnesses can be performed in the same way as allocation of medical treatment actions described above, except when medicine-specific processing, which will be described later, is added. For this reason, allocation of medicines to illnesses will be simply explained using the example of time t=2.

[0048] FIG. 5 shows an example of medical expense calculation processing when a medicine is linked to a receipt. In the example shown in FIG. 5, the receipt information 511 includes illness A, illness C, and illness D. In addition, medical procedure A, medical procedure B, and medicine Y are linked to the receipt information 511. Medical procedure A and medical procedure B are the same as those described above in FIG. 4A. That is, medical procedure A is a medical procedure that is selected regardless of the implementation of the indication master, and medical procedure B is a medical procedure that does not have a combination indicated by the indication master in relation to illness A, C, and D. Medicine Y is a medical procedure that has a combination indicated by the indication master in relation to illness C. In addition, illness C is an assigned illness described above in FIG. 4A and is an illness (already assigned illness 512) included in the receipt information 511. Illness D is a new illness (new illness 513) that is not included in the previous receipt information among the illnesses included in the receipt information 511. Illness A is a non-priority illness among the illnesses included in the medical receipt information 511.

[0049] The allocation determination unit 113 (1) first performs filtering on the prioritized injuries / illnesses (injuries / illnesses C and D) (515), and then (2) for the non-priority injury / illness (injury / illness A), combines the medical procedures that were not assigned to any of the injuries / illnesses in the filtering of (1), and filters the combination using the indication master (516).

[0050] First, the allocation specification unit 113 combines medical procedures A, B, and medicine Y for illnesses C and D to generate a combination 514 of medical procedures for new illnesses and previously assigned illnesses. Then, the allocation specification unit 113 applies filtering to the combination 514 using the indication master and previous receipt information (515). At this time, the allocation specification unit 113 applies filtering to the combination of medical procedures for a new illness (e.g., illness D) using the indication master. In the example shown in FIG. 5, medicine Y does not remain because there is no combination indicated by the indication master in relation to illness D. Also, medical procedure A is a medical procedure that remains regardless of the application of the indication master. Therefore, only medical procedure A is selected by filtering for the new illness D.

[0051] On the other hand, for the combination of medical procedures for illness C, which is an already assigned illness, filtering using the previous receipt information and filtering using the indication master are applied to the corresponding medical procedures. Filtering using the indication master is applied to drug Y, and it is assigned to illness C. In this way, illness C is combined with medical procedure A and drug Y, and illness D is combined with medical procedure A (516).

[0052] In addition, for filtering of medicines, processing specific to medicines may be performed. For example, first, for combinations of illnesses and medicines, filtering is performed using the indication master or previous receipt information prior to combinations of illnesses and medical procedures. Then, for combinations of illnesses and medicines remaining after filtering, illnesses that are combined with medicines related to anesthesia (for example, ATC classification N01) are identified (for example, anesthesia flag is set). Next, when filtering combinations of illnesses and medical procedures, for illnesses with anesthesia flag set, filtering is applied using the indication master, assuming that the name of the disease that is applicable to the combined medical procedure is "anesthesia". In this way, medical procedures and medicines can be more appropriately assigned to illnesses that require anesthesia during examination. This processing of assuming that the name of the disease that is applicable to the medical procedure is anesthesia may be applied not only to the case of t=2, but also to the case of t=1.

[0053] Next, the allocation specification unit 113 combines a medical procedure (medical procedure B) that was not assigned to any illness in the above filtering with an illness (illness A) that is not a priority illness. Furthermore, the allocation specification unit 113 performs filtering on the combination using the indication master (517). Note that, as described above in FIG. 4B, at this stage, medical procedure B is not assigned to illness A. Furthermore, the allocation specification unit 113 stores the previous receipt information in the storage unit 103. The allocation specification unit 113 also assigns the unassigned medical procedures included in the receipt information 511 to all illnesses. Thereafter, the medical cost calculation unit 114 calculates the medical costs for illnesses A, C, and D.

[0054] (A series of operations related to medical expense calculation processing) Next, a series of operations of the medical cost calculation process according to this embodiment will be described with reference to the flowcharts shown in Figures 6A and 6B. The medical cost calculation process is executed by the control unit 104 executing a program stored in the storage unit 103. In the following description, for convenience, a case where a medical procedure and a medicine are combined for an injury or illness will be described, but at least one of a medical procedure and a medicine may be combined with an injury or illness.

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

[0056] In S602, the control unit 104 determines whether the acquired medical receipt information is the initial medical receipt information (t=1). If the medical receipt information to be processed is the initial medical receipt information, the control unit 104 advances the process to S603, and if not, advances the process to S620 shown in FIG. 6B.

[0057] In S603, the control unit 104 determines whether the medical receipt information includes one injury or illness, and if so, proceeds to S610. On the other hand, if the medical receipt information includes more than one injury or illness, proceeds to S604. In S610, the allocation specification unit 113 allocates all medical procedures and medicines to one injury or illness, and proceeds to S609.

[0058] In S604, the dispensing data processing unit 115 executes a linking process for dispensing receipts. As described above, the dispensing data processing unit 115 links the information on the dispensing receipt to medical receipts (medical hospitalization, medical outpatient hospitalization, DPC) that include medical procedures such as prescription fees. The dispensing data processing unit 115 links the information on the dispensing receipt to the information on the medical receipt, and performs filtering using the indication master for combinations of drugs included in the dispensing receipt and illnesses on medical receipts (with medical procedures such as prescription fees). The dispensing data processing unit 115 makes it possible to refer to the illnesses on medical receipts (with prescription fees) associated with the drugs on the dispensing receipts obtained as a result of filtering using the indication master.

[0059] In S605 to S609, the allocation specification unit 113 or the medical cost calculation unit 114 executes the process of calculating medical costs for the illness on the receipt when t=1, as described above with reference to Fig. 4A. That is, the allocation specification unit 113 combines a medical procedure and a medicine for each illness included in the receipt information (S605). The allocation specification unit 113 applies the indication master to the combination of the medical procedure and medicine for the illness, and selects a practical combination of the illness and the medical procedure or medicine (S606).

[0060] Here, a process example for obtaining the association between the illness and the medicine in the indication master when applying the indication master will be described with reference to FIG. 7. First, the allocation specification unit 113 extracts the medicine code in the receipt, and specifies the ATC middle classification corresponding to the medicine code in the receipt from the corresponding medicine code in the medicine master 700. Next, the corresponding efficacy code is specified from the corresponding ATC middle classification in the medicine table 701. Then, the corresponding ICD small classification is obtained from the corresponding efficacy code in the indication disease name link table 702, and compared with the illness name (ICD10 small classification) included in the receipt. The medicine master 700 is a table including records such as the medicine code, the ATC middle classification, and the ATC middle classification name. The medicine table 701 is a table including the medicine name, the efficacy code, the ATC middle classification, and the like. Furthermore, 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 illness names (ICD10 small classifications) associated with a specific medicine can be specified.

[0061] The process for obtaining the relationship between the illness or injury in the indication master and the medical treatment related to the test will be described with reference to Fig. 8. In the indication disease name information file 800 shown in Fig. 8, the medical treatment fee chart category code and the ICD10 minor category are associated with each other. Therefore, the allocation specification unit 113 can specify the ICD10 minor category from the medical treatment fee chart category code.

[0062] The allocation specification unit 113 can obtain the relationship between the illness in the indication master and the medical procedure related to the examination, using a table 801 showing the medical procedure of surgery shown in Fig. 8. Since the table 801 also associates the medical fee chart category code with the ICD10 minor category, the allocation specification unit 113 can specify the ICD10 minor category from the medical fee chart category code.

[0063] Returning to the explanation of FIG. 6A, the allocation specification unit 113 stores the previous receipt information obtained by the process of S606 in the storage unit 103 (S607), and allocates the unallocated medical procedures and unallocated medicines to all injuries and illnesses (S608). Finally, the medical cost calculation unit 114 calculates the medical cost for the injury or illness using the medical costs (points) of the medical procedures and medicines allocated to each injury or illness (S609). Here, if there is one injury or illness, the allocation specification unit 113 stores the result obtained by the process of S610 in the storage unit 103 as the previous receipt information, and the medical cost calculation unit 114 calculates the medical cost for the injury or illness (S609).

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

[0065] The process for the next medical receipt information (t=2) will be described with reference to Fig. 6B. In S620, the control unit 104 determines whether the medical receipt information includes one injury or illness, and if so, proceeds to S630. On the other hand, if the medical receipt information includes more than one injury or illness, proceeds to S621. In S630, the allocation specification unit 113 allocates all medical procedures and medicines to one injury or illness, and 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 in S604.

[0067] In S622 to S628, the allocation specification unit 113 or the medical cost calculation unit 114 executes the process of calculating medical costs for the illness of the receipt when t=2, as described above with reference to FIG. 4B (to FIG. 4D and FIG. 5). That is, the allocation specification unit 113 identifies the prioritized illness (new illness, already assigned illness) included in the receipt information, and combines medical procedures and medicines for the identified illness (S622). The allocation specification unit 113 applies filtering based on the indication master and previous receipt information to the combination of medical procedures and medicines for the prioritized illness (S623), and selects a practical combination of the illness and medical procedures or medicines or a combination that has already been used (S624). Furthermore, the allocation specification unit 113 applies the indication master to the combination of medical procedures and medicines for the non-prioritized illness and selects a practical combination of the non-prioritized illness and medical procedures or medicines (S625). Furthermore, the allocation specification unit 113 stores the previous receipt information obtained by the process of S625 in the storage unit 103 (S626), and allocates the unallocated medical procedures and unallocated medicines to all injuries and illnesses (S627). Finally, the medical cost calculation unit 114 calculates the medical cost for the injury or illness using the medical costs (points) of the medical procedures and medicines allocated to each injury or illness (S628). Here, if there is one injury or illness, the allocation specification unit 113 stores the result obtained by the process of S630 in the storage unit 103 as the previous receipt information, and the medical cost calculation unit 114 calculates the medical cost for the injury or illness (S628).

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

[0069] As described above, in this embodiment, the allocation of medical treatments and medicines linked to the receipts is specified for the illnesses included in the receipt information by using the information on the receipts configured in a time series. At this time, based on the information on the illnesses included in the receipt information of t=1 among the multiple receipt information, the priority illnesses (new illnesses and already assigned illnesses) among the illnesses included in the receipt information after t=1 (for example, t=2) are identified. Then, the allocation of medical treatments or medicines for the illnesses included in the receipt information of t=2 is specified by using a combination of the priority illnesses and the medical treatments or medicines linked to the receipt information of t=2. In this way, it is possible to preferentially allocate illnesses with a high degree of certainty to new illnesses or illnesses for which medical treatments have actually been performed in the past. In other words, it is possible to more accurately calculate medical expenses for each illness listed on the receipt.

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

[0071] 100: information processing server, 103: storage unit, 104: control unit, 112: receipt information acquisition unit, 113: allocation 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 device, the information processing device comprising: An acquisition means for acquiring a plurality of pieces of receipt information for a specific patient, the plurality of pieces of receipt information being created in chronological order; A means for identifying an allocation of a medical procedure or a medicine associated with the medical receipt information for an injury or illness included in the medical receipt information; A calculation means for calculating medical expenses for an injury or illness based on the points of medical procedures or medicines assigned to the injury or illness, The identification means identifies a prioritized injury or illness among the injuries or illnesses included in the second receipt information based on information on the injury or illness included in first receipt information among the multiple receipt information and information on the injury or illness included in second receipt information generated after the first receipt information, identifies a combination of the prioritized injury or illness with a first medical procedure or medicine linked to the second receipt information, and then identifies an allocation of a medical procedure or medicine to the injury or illness included in the second receipt information by combining an injury or illness that is not a prioritized injury or illness with a second medical procedure or medicine linked to the second receipt information that is different from the first medical procedure or medicine.

2. The program described in claim 1, characterized in that the identification means identifies a new injury or illness among the injuries or illnesses included in the second receipt information that is not included in the first receipt information as the prioritized injury or illness, and identifies an allocation of medical procedures or medicines to the injuries or illnesses included in the second receipt information so as to include a combination of the new injury or illness and a medical procedure or medicine included in the first medical procedure or medicine.

3. The program according to claim 1 or 2, characterized in that the identification means identifies a specified injury or illness already included in the first receipt information to which a medical procedure or medicine linked to the first receipt information has been pre-assigned among the injuries or illnesses included in the second receipt information as the prioritized injury or illness, and identifies an allocation of a medical procedure or medicine to the injury or illness included in the second receipt information so as to include a combination of the already-assigned specified injury or illness and a medical procedure or medicine included in the first medical procedure or medicine.

4. The predetermined injury or illness mentioned above is an injury or illness related to a combination selected as a combination indicated by an indication master from among combinations of an injury or illness included in the first medical receipt information and a medical procedure or a drug linked to the first medical receipt information, and includes an injury or illness identical to an injury or illness included in the second medical receipt information, 4. The program according to claim 3, wherein the indication master is a practical, predetermined combination of an injury or illness and a medical procedure or drug that may be included in prescription information.

5. The identification means, when identifying an allocation of a medical procedure or a medicine for an injury or illness included in the second medical receipt information, selects a combination indicated by an indication master from among combinations of the injury or illness identified as the prioritized injury or illness and the medical procedure or medicine linked to the second medical receipt information, 4. The program according to claim 1, wherein the indication master is a practical, predetermined combination of an injury or illness and a medical procedure or medicine that may be included in prescription information.

6. The program described in claim 5, characterized in that, among the combinations of the injury or illness identified as the prioritized injury or illness and the medical procedure or medicine linked to the second prescription information, a combination of the injury or illness identified as the prioritized injury or illness and the medical procedure that is selected regardless of the selection made by the indication master is selected in addition to the combinations indicated by the indication master.

7. The program described in Claim 6, characterized in that the medical procedure selected regardless of the selection made by the indication master is a medical procedure that is not classified as an examination or surgery according to the medical fee chart classification number.

8. The program described in claim 6 or 7, characterized in that the identification means identifies a specified injury or illness already included in the first receipt information to which a medical procedure or medicine linked to the first receipt information is pre-assigned among the injuries or illnesses included in the second receipt information, and selects a combination of the specified injury or illness already included in the first receipt information and the predetermined medical procedure, and a combination indicated by the indication master, from among combinations of the specified injury or illness already included in the first receipt information and the medical procedure or medicine linked to the second receipt information.

9. A program as claimed in any one of claims 1 to 8, further comprising a linking means for linking an injury or illness contained in prescription information describing a medical procedure defined as a prescription fee, etc., according to a medical fee chart classification number, with a medicine contained in prescription information of a dispensing prescription.

10. The program according to any one of claims 1 to 9, characterized in that the multiple prescription information is stored in a memory means in a chronological order in which it was created, for at least one of patient, medical institution, department, and type of prescription.

11. An information processing method in which each step is executed by an information processing device, An acquisition step of acquiring a plurality of pieces of receipt information for a specific patient, the plurality of pieces of receipt information being created in chronological order; A step of identifying an allocation of a medical procedure or a medicine associated with the medical receipt information for an injury or illness included in the medical receipt information; A calculation step of calculating medical expenses for the injury or illness based on the points of medical procedures or medicines assigned to the injury or illness, The identification process identifies a prioritized injury or illness among the injuries or illnesses included in the second receipt information based on information on the injury or illness included in first receipt information among the multiple receipt information and information on the injury or illness included in second receipt information generated after the first receipt information, identifies a combination of the prioritized injury or illness with a first medical procedure or medicine linked to the second receipt information, and then identifies an allocation of a medical procedure or medicine to the injury or illness included in the second receipt information by combining an injury or illness that is not a prioritized injury or illness with a second medical procedure or medicine linked to the second receipt information that is different from the first medical procedure or medicine.

12. An acquisition means for acquiring a plurality of pieces of receipt information for a specific patient, the plurality of pieces of receipt information being created in chronological order; A means for identifying an allocation of a medical procedure or a medicine associated with the medical receipt information for an injury or illness included in the medical receipt information; A calculation means for calculating medical expenses for an injury or illness based on the points of medical procedures or medicines assigned to the injury or illness, The identification means identifies a prioritized injury or illness among the injuries or illnesses included in the second receipt information based on information on the injury or illness included in first receipt information among the multiple receipt information and information on the injury or illness included in second receipt information generated after the first receipt information, identifies a combination of the prioritized injury or illness with a first medical procedure or medicine linked to the second receipt information, and then identifies an allocation of a medical procedure or medicine to the injury or illness included in the second receipt information by combining an injury or illness that is not a prioritized injury or illness with a second medical procedure or medicine linked to the second receipt information that is different from the first medical procedure or medicine.

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