Disease and Injury Name Management System
The disease name management system addresses issues of mismanagement in medical settings by ensuring accurate assignment and deletion of disease names, preventing reduced assessments and clarifying patient conditions.
Patent Information
- Authority / Receiving Office
- JP · JP
- Patent Type
- Patents
- Current Assignee / Owner
- INST OF MEDICAL INFORMATION TECH CO LTD
- Filing Date
- 2026-01-28
- Publication Date
- 2026-06-10
AI Technical Summary
In medical settings, there are challenges in accurately managing disease names and medical procedures, leading to forgotten or missed conversions of suspected diagnoses to confirmed diagnoses, redundant assignments, and failure to delete cured disease names, which results in reduced medical fee assessments and unclear patient conditions.
A disease name management system that includes means for managing applicable disease names for each medical procedure, determining appropriate relationships, deleting unnecessary disease names, and assigning appropriate disease names, while also considering similar disease names for deletion.
Prevents the forgetting of disease names, ensures accurate conversion of suspected to confirmed diagnoses, promptly deletes cured disease names, and avoids redundant assignments, thereby maintaining accurate medical fee assessments and clear patient condition understanding.
Smart Images
Figure 0007872562000001_ABST
Abstract
Description
Technical Field
[0001] The present invention relates to a disease name management system that assigns the disease names necessary for a claim in claim for medical fees and deletes the disease names that have become unnecessary.
Background Art
[0002] In medicine, various examinations are conducted for the diagnosis and treatment of diseases suffered by patients. As a result of the diagnosis, the disease name is determined, and medical acts such as examinations and treatments are performed for the disease. The costs required for the examinations and medical acts performed are claimed to a payment fund or the like as a medical fee claim form (commonly called a receipt), and the medical institution is paid the medical fee. Disease names are standardized as disease name codes based on international standards such as ICD10. Also, medical acts are standardized with claim codes and reimbursement amounts (points at 10 yen per point) for each examination and treatment act. A receipt basically consists of a list of the disease name codes of the patient and a list of claim codes for each medical act. Previously, handwritten receipts based on handwritten medical records were created, but currently, it has become mainstream to extract disease names and medical acts from electronic medical records, create receipts electronically, and send them electronically to a payment fund or the like. A list of claimable medical acts is determined for each disease name, and a list of disease names (applicable disease names) claimable for each medical act is also determined. Claims for medical acts without corresponding applicable disease names (disease name omission) are subject to a reduced assessment. The rule for the reduced assessment due to disease name omission does not allow for reinstatement, and a necessary and sufficient list of disease names is the most important matter when creating a receipt. Also, when a disease is cured by a medical act and the medical act becomes unnecessary, it is encouraged to delete the disease name each time. The following are the prior art documents related to this application.
Prior Art Documents
Patent Documents
[0003] [Patent Document 1] Patent No. 6651114 [Patent Document 2] Patent No. 5134061 [Overview of the project] [Problems that the invention aims to solve]
[0004] To determine the diagnosis of a patient's injury or injury, a medical history is taken, a physical examination is performed, and blood tests, X-rays, CT scans, MRI scans, and other radiological tests are conducted to confirm the diagnosis (examination procedures). However, a diagnosis is not reached immediately; several possible diagnoses are considered (suspected diagnoses), and the examination and tests proceed accordingly. Once a diagnosis is confirmed (definitive diagnosis), the suspected diagnoses are changed to confirmed diagnoses, and all other suspected diagnoses are deleted. Treatment is only permitted for confirmed diagnoses. In busy outpatient settings, it is common for doctors to forget to assign suspected diagnoses, delete suspected diagnoses after a confirmed diagnosis has been made, or fail to change suspected diagnoses to confirmed diagnoses after treatment has already begun. All of these are subject to reduction in medical fee assessments. Disease names that have been treated and no longer require medical intervention (healed) must be deleted. However, there are multiple medical procedures permitted for each disease name, and multiple disease names that are permitted for each medical procedure. In other words, the correspondence between disease names and medical procedures is not one-to-one, but many-to-many. If a disease name corresponding to a medical procedure that is no longer needed is carelessly deleted, there is a risk that another medical procedure corresponding to the disease name being deleted will be left unlisted, which could lead to a reduction in the assessment of medical expenses. For this reason, deleting disease names is a delicate task and is often postponed. As a result, the list of disease names becomes like the "end credits of a movie," hindering the understanding of the patient's condition. Furthermore, during the course of diagnosis, similar disease names may be assigned redundantly, which is not considered desirable.
[0005] The present invention has been made to solve the aforementioned problems of the past, and its purpose is to provide a disease name management system that prevents forgetting to assign disease names, forgetting to convert suspected disease names to confirmed disease names, inconsistencies between the body part treated and the body part of the disease name, forgetting to delete suspected disease names that are no longer needed, promptly deletes disease names that have been cured by treatment and no longer require medical treatment, and deletes disease names with duplicate content. [Means for solving the problem]
[0006] As a means to achieve the above objective, the disease name management system according to claim 1, in creating a medical fee claim form (receipt) for each patient that includes a list of disease names and a list of medical procedures performed, (1) A means for managing a list of applicable disease names for each medical procedure, (2) The system is equipped with means for determining whether there is an appropriate relationship between a medical procedure and a disease name, For all combinations of the medical procedure performed and the already assigned disease name, the presence or absence of an appropriate relationship is determined using the appropriate relationship determination means. (a) A list of all medical procedures that are applicable to each disease name already assigned (medical procedures applicable to each disease name), (b) Obtain a list of all already assigned disease names that are applicable to each medical procedure (applicable disease names for each medical procedure), Disease names with zero medical procedures performed will be deleted. The system is characterized by having a means for determining which disease names to be deleted, which selects the disease name with the shortest list of applicable medical procedures for each disease name as a disease name to be considered for deletion, and for all of the lists of applicable medical procedures for the disease name to be considered for deletion, if there are applicable disease names other than the disease name to be considered for deletion in the list of applicable disease names for each medical procedure, then determines that the disease name to be considered for deletion is a disease name to be deleted.
[0007] The disease name management system according to claim 2 is characterized in that, in the disease name management system according to claim 1, for each of the medical procedures listed in the medical fee claim form, the presence or absence of an applicable disease name is determined using all the disease names listed in the medical fee claim form and the applicable relationship determination means, and if there is no applicable disease name, the disease name assignment means is provided to select an applicable disease name for the medical procedure from the list of applicable disease names for each medical procedure and assign it as the disease name for the patient.
[0008] The disease name management system according to claim 3 is characterized in that, in the disease name management system according to claim 1, the system includes a similar disease name determination means that, in the "list of all medical procedures that are applicable to each already assigned disease name (medical procedures applicable to each disease name)", disease names in which the "all medical procedures that are applicable to each disease name" are similar to each other, and disease names in which the corresponding medical procedures overlap, are considered as similar disease names and are subject to deletion.
[0009] In the disease name management system according to claim 4, in the disease name management system according to claim 1, in the "list of all medical procedures that are applicable to each already assigned disease name (medical procedures applicable to each disease name)", the " List of applicable medical procedures for each disease / injury The system is characterized by having a means for changing the name of a suspected illness to a confirmed illness, which determines whether a medical procedure is included in the suspected illness and, if so, changes the name of the suspected illness to a confirmed illness. [Effects of the Invention]
[0010] The disease name management system described in claim 1 includes means for managing a list of applicable disease names for each medical procedure, means for determining the applicability relationship, a list of medical procedures (applicable medical procedures for each disease name), and means for determining disease names to be deleted. This prevents forgetting to assign disease names, forgetting to convert suspected disease names to confirmed disease names, mismatches between the body part of the medical procedure and the body part of the disease name, and forgetting to delete suspected disease names that are no longer needed. Furthermore, the names of illnesses and injuries that have been cured through treatment and no longer require medical intervention will be promptly removed.
[0011] In the injury / disease name management system according to claim 2, since it includes an injury / disease name assignment means, for each of the medical act lists described in the medical fee claim form, it determines the presence or absence of applicable injury / disease names using all the injury / disease names described in the medical fee claim form and the said adaptation relationship determination means. If there is none, it selects the applicable injury / disease name for the said medical act from the list of applicable injury / disease names for each medical act and assigns it as the injury / disease name of the said patient.
[0012] In the injury / disease name management system according to claim 3, since it includes a similar injury / disease name determination means, in the "list of all medical acts (medical acts applicable to each injury / disease name) that have an adaptation relationship for each already assigned injury / disease name", it considers injury / disease names where the said "all medical acts having an adaptation relationship" are mutually similar and the corresponding medical acts overlap as candidates for deletion as similar injury / disease names.
[0013] In the injury / disease name management system according to claim 4, since it includes a confirmed injury / disease name change means, in the "list of all medical acts (medical acts applicable to each injury / disease name) that have an adaptation relationship for each already assigned injury / disease name", it determines whether a treatment act is included in the said "list of medical acts applicable to each injury / disease name" of the suspected injury / disease name. If it is included, it changes the suspected injury / disease name to a confirmed injury / disease name.
Brief Description of the Drawings
[0014] [Figure 1(A)] An example of a receipt. [Figure 1(B)] An example of a receipt. [Figure 2] Shows the basic structure of a receipt. [Figure 3] Shows an example of a list of applicable injury / disease names determined for each medical act (medical act applicable injury / disease name list management means). [Figure 4] Shows the correspondence from the performed medical acts to injury / disease names. [Figure 5] Shows the mutual correspondence between injury / disease names and medical acts. [Figure 6] Shows a flowchart for deleting unnecessary injury / disease names.
Embodiments for Carrying Out the Invention
[0015] Figures 1(A) and (B) show an example of a medical receipt. (A) and (B) are a series of medical receipts of the same patient. Personal information parts have been deleted / concealed. Once, it was filled in by hand on a paper receipt, but now almost all are electronic receipts. The names of diseases and injuries and the codes of each medical act are filed in a certain format and electronically transmitted to the payment fund. However, since the image of the paper receipt era is deeply rooted, in the creation and review of receipts, visual inspection is often performed in the format shown in Figures 1(A) and (B). In Figure 1(A), a large number of names of diseases and injuries are listed in the disease and injury name column. There are names of diseases and injuries necessary for current medical acts, but there are also names of diseases and injuries that have already been treated and are no longer necessary, resulting in the "movie end credits" state.
[0016] Figure 2 shows the basic structure of a medical receipt. The list of names of diseases and injuries is a list of the names of diseases and injuries targeted for the diagnosis and treatment of a patient. For a disease or injury name with a (suspicion) attached, when conducting examinations or the like to confirm the disease or injury name for a possible disease or injury name, the (suspected disease or injury name) indicates which disease or injury name was suspected when conducting the examination. Once the disease or injury name is confirmed, it is necessary to remove the (suspicion) from the disease or injury name to make it a confirmed disease or injury name, and delete the suspected disease or injury name that did not apply (confirmed disease or injury name change means). Medical act items consist of examination act items (parts 60 and 70 in Figure 1(B)) conducted for the diagnosis confirmation of a disease or injury name, measurement of treatment effects, etc., and treatment act items such as drug prescriptions and treatments for the confirmed disease or injury name. Each item of a medical act needs to correspond to a disease or injury name (applicable disease or injury name) for which implementation is recognized (there is an indication of applicability).
[0017] Figure 3 shows an example of a list of applicable disease or injury names defined for each medical act (management means for the list of applicable disease or injury names for each medical act). While there may be a single applicable disease or condition, there are usually multiple applicable conditions. For each medical procedure listed on the medical fee claim form, the system includes a means for determining whether each of the disease names listed on the medical fee claim form corresponds to an applicable disease name (applicability relationship determination means). If there is no applicable disease name for the medical procedure, the system includes a means for assigning a disease name that selects an applicable disease name for the medical procedure from the list of applicable disease names for each medical procedure and assigns it as the disease name for the patient, thereby preventing the omission of disease names.
[0018] Figure 4 is a graph showing the correspondence between each medical procedure and each disease name. A single disease name has a corresponding relationship as an applicable disease name for one or more medical procedures, and conversely, a single medical procedure usually has a corresponding relationship as an applicable disease name for one or more disease names (means for determining applicability). Medical procedures that include one or more applicable disease names in the list of diseases already assigned to the patient are not subject to review. On the other hand, medical procedures for which no applicable disease name exists will be subject to review as a lack of disease name. To prevent the assessment of this medical procedure, it is essential to assign a corresponding disease name to the medical procedure, as shown in Figure 2. By presenting a list of applicable disease names corresponding to the medical procedure in question and selecting and assigning the appropriate disease name (disease name assignment method), assessments due to the omission of disease names can be prevented.
[0019] For illnesses or injuries where treatment has ended and no further medical procedures are being performed, there are no corresponding medical procedures. It is appropriate to delete such illness or injury names. When only a few medical procedures correspond to a particular illness or injury, there are two possibilities. The first possibility is that the name of the illness or injury is essential for the medical procedure in question. This applies when the medical procedure in question is applicable to that disease or injury name alone. In this case, deleting the disease name would significantly increase the risk of omissions in disease diagnoses. The second possibility is that the aforementioned few medical procedures were not performed for the disease name being considered for deletion, but rather for a different disease name assigned to the patient, but that there happens to be a corresponding disease name for which the procedures are applicable. In this case, since another disease name remains as the applicable disease name for the medical procedure in question, deletion is possible without the risk of omission of disease names.
[0020] Figure 5 is a tabular representation of the relationship between each medical procedure and each disease name shown in Figure 4. Disease names 1 and 2 correspond to many medical procedures and are likely the patient's so-called "primary diagnoses." From another perspective, there is a high probability that the corresponding medical procedures overlap, indicating the same underlying condition. In this case, deleting one of the disease names may clarify the patient's condition. Thus, it is useful to have a means for determining similar disease names that are considered for deletion as similar disease names if the corresponding medical procedures overlap within the disease name list. While the degree of similarity between disease names can be easily measured by the overlap of corresponding medical procedures, if there are three or more similar disease names, or if numerous medical procedures are intricately involved, the characteristic vectors of the medical procedure groups corresponding to the disease names can be obtained, and disease names with highly correlated characteristic vectors can be considered similar disease names. It is best to leave the decision of whether or not to actually delete an entry, and which of the similar disease names to retain, to the attending physician.
[0021] Figure 6 shows a flowchart for deleting unnecessary disease names (means for determining disease names to be deleted). First, from the list of disease names to be considered as unnecessary (list of target disease names), select the disease name that requires the fewest corresponding medical procedures (disease name to be considered for deletion). In this diagram, disease name 3 is the relevant category. Since there is no list of medical procedures for disease name 3, disease name 3 will be deleted and removed from the list of target disease names. Next, we move on to disease name 5, which involves fewer medical procedures. Only 6 requires a medical procedure. If we temporarily delete disease name 5 here, there will be no disease name for medical procedure 6 (a state of missing disease name), so disease name 5 cannot be deleted. The temporary deletion will be canceled, and disease name 5 will be added to the list of saved disease names (saved disease names) and removed from the list of target disease names.
[0022] Next, let's consider the fourth diagnosis. The corresponding medical procedures are 1 and 3. The disease names corresponding to medical procedure 1 are 1, 2, and 4. Furthermore, the disease names corresponding to medical procedure 3 are 1, 2, and 4. Even if disease name 4 is temporarily deleted, disease names 1 and 2 remain for both medical procedures, so there will be no missing disease names. Delete disease name 4 and remove it from the list of target diseases. Following a similar procedure, disease names 1 and 6 will remain in the list of preserved disease names. By deleting all other disease names from the medical record, unnecessary disease names can be removed without the risk of omissions. For suspected diagnoses, if a treatment procedure is included in the list of related medical procedures, it will be treated as a confirmed diagnosis, and the "(suspected)" designation will be removed. If only testing is performed and no medical procedure is performed, the procedure will be discontinued (method for changing confirmed diagnosis).
[0023] Although embodiments have been described above, the specific configuration of the present invention is not limited to the embodiments described above, and design changes and the like that do not depart from the spirit of the invention are also included in the present invention.
Claims
1. In creating a medical fee claim form (receipt) for each patient, which includes a list of illnesses and injuries and a list of medical procedures performed, (1) A medical procedure-specific disease name list management system for managing a list of applicable disease names for each medical procedure, (2) The system is equipped with means for determining whether a medical procedure and a disease name are in an appropriate relationship, For all combinations of the medical procedure performed and the already assigned disease name, the presence or absence of an appropriate relationship is determined using the appropriate relationship determination means. (a) A list of all medical procedures that are applicable to each disease name already assigned (medical procedures applicable to each disease name), (b) A disease name management system characterized by comprising a means for determining disease names to be deleted, which obtains a list of all already assigned disease names that are applicable to each medical procedure (applicable disease names for each medical procedure), deletes disease names for which the number of medical procedures is 0, selects the disease name with the shortest list of applicable medical procedures for each disease name as a disease name to be deleted, and for all of the lists of applicable medical procedures for the disease name to be deleted, if there are applicable disease names other than the disease name to be deleted in the list of applicable disease names for each medical procedure for that medical procedure, it determines that the disease name to be deleted is a disease name to be deleted.
2. The disease name management system according to claim 1, characterized in that, for each of the medical procedures listed in the medical fee claim form, it determines whether there is an applicable disease name using all the disease names listed in the medical fee claim form and the applicable relationship determination means, and if there is no applicable disease name, it selects an applicable disease name for the medical procedure from the list of applicable disease names for each medical procedure and assigns it as the disease name for the patient.
3. The disease name management system according to claim 1, characterized in that, in the "list of all medical procedures that are applicable to each already assigned disease name (medical procedures applicable to each disease name)", the system includes a similar disease name determination means that considers disease names that are similar to each other among the "all medical procedures that are applicable to each disease name" as similar disease names and disease names whose corresponding medical procedures overlap as similar disease names to be subject to deletion.
4. The disease name management system according to claim 1, characterized in that it includes a means for changing the suspected disease name to a confirmed disease name, which determines whether a treatment procedure is included in the "list of medical procedures applicable to each disease name" for the suspected disease name, and if it is included, changes the suspected disease name to a confirmed disease name.