基于电子病历的智慧医保探讨  

Exploration of Smart Medical Insurance Based on Electronic Medical Records

作　　者：刘颜[1] 张海峤[1] 陈寒杰 靳洁 孙逸凡 林创鹏 汤鑫 徐源 许昌 陈芸[1] LIU Yan;ZHANG Hanqiao;CHEN Hanjie(不详;Peking University Shenzhen Hospital,Shenzhen,Guangdong,518036,China)

机构地区：[1]北京大学深圳医院,广东深圳518036 [2]武汉医有数网络科技有限公司,湖北武汉430010 [3]清华大学医院管理研究院,广东深圳518055

出　　处：《中国卫生质量管理》2023年第10期15-19,共5页Chinese Health Quality Management

基　　金：广东省卫生经济学会科研项目基金(编号:2022-WJMF-25);深圳市卫生经济学会科研项目基金(编号:202265);北京大学深圳医院智慧医院研究项目基金(编号:BDSYZYY-20221212-L-06);北京大学深圳医院管理横向课题基金(编号:JCYJ2021009)。

摘　　要：智慧医保是医疗保障事业发展的现实目标。探讨以电子病历为核心建立智慧医保模式,从提升智慧医保系统质量、强化病案编码培训、重视智慧医保审核模块建设等方面着手,促进医保费用的合理使用。认为建立智慧医保大数据中心,完善智慧医保在院监测功能,完善医保结算管理模块,建立工作评价机制是智慧医保系统发展方向。Smart medical insurance is the realistic goal of the development of medical insurance.The study explored the establishment of a smart medical insurance mode with electronic medical records as the core,and promote the rational use of medical insurance expenses from the aspects of improving the quality of smart medical insurance system,strengthening the training of medical record coding,and attaching importance to the construction of smart medical insurance review module.It was believed that the future development direction of the smart medical insurance system is to establish the smart medical insurance big data center,improve the monitoring function of smart medical insurance in the hospital,improve the medical insurance settlement management module,and establish the work evaluation mechanism.

关 键 词：电子病历 智慧医保 医保费用 DRG DIP 

分 类 号：R197.324[医药卫生—卫生事业管理]