基于信息系统的医院医保管理开发与建议  

Developments and Suggestions for the Hospital Medical Insurance Based on the Information System

作　　者：江海林[1] 

机构地区：[1]南通大学附属医院,南通226001

出　　处：《中国医疗保险》2014年第5期53-55,共3页China Health Insurance

摘　　要：南通大学附属医院为提升医保管理水平,在医院医保管理信息系统开发了一套面向医保患者、以临床医嘱为源头的智能指引信息系统,包括以医保三个目录使用为核心的智能指引、抗生素使用的分级管理指引、门诊特病用药目录的嵌入管理、贵重药品控制与医保合理性监控;嵌入控费与分析支撑模块,包括报表分析系统、费用预警体系、病历和处方在线查询管理;开发医保患者查询与服务模块等,为医疗服务过程贯彻落实相关医保政策、减少违规行为提供了现代化的技术支撑。o improve the level of medical insurance management, the Affiliated Hospital of Nantong University developed a set of intelligent information guiding system for insured patients and the clinical doctors, which includes the intelligent guidance centralized on the usage of three medicine directories of medical insurance, the classified usage management of antibiotic drugs, the embedded management of drug list for outpatients with special disease, the control of the usage of expensive medicines and the monitor of the rationality of health care. The embedded modules for expenditure control and analysis, which includes report analysis system, cost early warning system, medical records and prescriptions online query management, as well as the modules for insured patients to query and seek service etc. were also exploited. These approaches provide modernized technical support for the implementation of relevant medical insurance policy in the process of providing health care and reduce the risk of violations in health care.

关 键 词：医院 医疗保险 管理 信息系统 

分 类 号：R197.32[医药卫生—卫生事业管理] F842.684[医药卫生—公共卫生与预防医学]