外联业务中台在医院医保惠民服务中的应用实践

The Practice and Experience of Outreach Business Middleground in Medical Insurance Service System

本文提出了一种基于外联业务中台建设医保惠民服务系统的整体设计,通过统一的数据标准、业务流程控制和网络安全管理,实现医保惠民服务与医院诊疗便民服务统一平台管理、医保服务入口统一接入和医保服务安全管控。通过在本院的应用实践,实现了基于中台模式的医保诊间无感支付、医保自助结算服务,并可基于中台架构自由拓展新的服务应用,未来医院更换HIS等系统或者医保中心结算系统调整,都不需要对院内系统进行大范围改造。

In this paper,we put forward an overall design of medical insurance service system based on outreach business middleground.Through unified data standards,business process control and network security management,we can realize unified platform management of medical insurance service and hospital diagnosis and treatment service,unified access of medical insurance service entrance and security control of medical insurance service.Through the author's application practice in our hospital,the non-inductive payment between medical insurance clinics and self-service settlement service of medical insurance based on the middleground model are realized,new service applications can be freely expanded based on the middleground architecture.In the future,there is no need for large-scale transformation of the hospital system when the hospital changes the HIS or other systems or adjusts the settlement system of medical insurance centers.