基于HIS的医保清单管理系统的设计与实现

Design and implementation of HIS-based medical insurance list management system

目的:设计基于医院信息系统(hospital information system,HIS)的医保清单管理系统,实现医院医保清单的实时审核和上传。方法:该系统采用客户端/服务器(Client/Server,C/S)架构设计,其中服务端基于HIS的Oracle数据库开发,客户端采用PowerBuilder 9.0工具开发。整个系统由自动反馈、统计查询、清单审核、清单上报和字典维护5个功能模块构成,采用数据字典对照、数据库函数等技术实现医保清单数据标准化,并采用结构化查询语言(structured query language,SQL)从HIS中自动获取医保清单指标数据,经医保部门和病案部门的双重审核后完成医保清单的上传。结果:该系统可实现医保清单监测查询、审核上传、反馈修改、汇总分析的全流程闭环管理,可有效提高医保清单的实时性和准确性。结论:采用该系统可及时、高效、准确地上传医保清单,有利于提升医院的医保清单管理水平。

Objective To design a medical insurance list management system based on hospital information system(HIS)to realize real-time audit and upload of the hospital medical insurance list.Methods A medical insurance list management system with C/S architecture had its server terminal developed with the Oracle database of HIS and client terminal with PowerBuilder 9.0 tool.The system developed was composed of five functional modules for automatic feedback,statistics and query,list audit,list upload and dictionary maintenance.The data of the medical insurance list were standardized with the technologies of data comparison dictionary and database function,and the medical insurance list index data were acquired from HIS automatically with structured query language,then the medical insurance list was uploaded after the dual-audit by the medical insurance department and medical case department.Results The system realized the whole process of medical insurance list closed-loop management involving in monitoring and query,audit and upload,feedback and modification and summary analysis,and the timeliness and accuracy were both enhanced for the medical insurance list.Conclusion The system developed uploads the medical insurance list timely,efficiently and accurately,and improves the hospital management for the medical insurance list.[Chinese Medical Equipment Journal,2023,44(5):40-44]