基于大数据技术的病案智能编码系统的功能设计与应用

Design and Application of Medical Record Intelligent Coding System based on Big Data Technology

针对传统病案编码模式下工作量大、编码过程抽象、枯燥、重复性操作多,容易出错等弊端,设计了一种基于大数据技术的智能编码系统。该系统与医院病案系统对接,以可自学习的知识库为核心技术,通过ICD标准编码规范和原始数据对病案进行自动编码。该系统的应用使编码员的精力和时间主要放在前3个出院诊断和手术操作编码的审核上,简化了工作流程、提高了效率、降低了错误率,无论是对编码工作的流程管理还是编码人员的工作效率、质量以及水平都有了一个质的飞跃。

An intelligent coding system based on big data technology is designed to overcome the disadvantages of heavy workload, abstract, boring, repetitive operation and error prone in the traditional medical record coding mode. The system is connected with the hospital medical record system. The self-learnable knowledge base is used as the core technology, and the medical record is automatically coded by ICD standard coding specification and original data. The application of the system makes the coder＇s energy and time mainly in the approval of the first three discharge diagnosis and surgical operation coding, simplifies the coding workflow, improves the coding efficiency, and reduces the coding error rate. Coding quality and coding level have made a qualitative leap both in the process management of the coding work and in the work efficiency of the coding personnel.