国家医保接口环境下门诊先诊疗后结算系统的改造及应用  

Renovation and Application of Outpatient First Care Pay Later System Based on the National Medical Insurance Interface System

作　　者：方卫青[1] 陈川 王逸新 张兰[1] FANG Weiqing;CHEN Chuan;WANG Yixin;ZHANG Lan(Department of Information,Changshu No.2 People’s Hospital,Suzhou Jiangsu 215500,China;Department of Implementation,Winning Health Technology Group Co.,Ltd.,Changzhou Jiangsu 213000,China)

机构地区：[1]常熟市第二人民医院信息处,江苏苏州215500 [2]江苏卫宁健康有限公司实施部,江苏常州213000

出　　处：《中国医疗设备》2024年第3期86-91,共6页China Medical Devices

基　　金：2022常熟市科技计划社会发展项目(CS202208)。

摘　　要：目的 实现门诊患者在国家医保接口环境下的先诊疗后结算系统的改造和应用。方法 基于对医院现有业务流程和接口功能的分析,结合市域级信用体系,对医院信息系统(Hospital Information System,HIS)前台的挂号和结算环节分别调用市域级信用体系的注册和销号接口,实现一次挂号一次结算。配合HIS后台存储的患者状态进行院内流程优化,从而实现先诊疗后结算。结果 实现了在国家医保接口环境下医院门诊患者先诊疗后结算业务流程的重塑,采用先诊疗后结算模式的患者就诊时平均排队次数减少0.52次,平均等候时长缩短6.84 min。结论 通过对HIS的改造,简化了门诊患者就诊流程,并通过引入市域级信用体系保证了市域范围内费用的有效控制,对降低门诊患者在院滞留时间有积极意义,对于国家医保环境下医院门诊优化流程有借鉴意义。Objective To realize the renovation and application of thefirst care pay later system for outpatients depending on the national medical insurance interface.Methods Based on the analysis of the existing business processes and interface functions of the hospital,combined with the municipal credit system,the registration and settlement processes of the hospital information system(HIS)front-end were respectively called through the registration and cancellation interfaces of the municipal credit system,so as to realize one registration and one settlement.The in-hospital process was optimized by storing the patient status in the database of the HIS,so as to realizefirst care pay later.Results Under the national medical insurance interface environment,the business process of hospital outpatient first care pay later was reshaped.The average number of queues and waiting time of the patients who adopted the mode of treatmentfirst and then settlement were reduced by 0.52 times and 6.84 min,respectively.Conclusion The renovation of the HIS streamlines the outpatient consultation process and ensures effective cost control within the city by introducing municipal credit system.It has positive implications for reducing the staying time of outpatients in hospital,and has implication for optimizing the process in hospital outpatient clinics in the national health insurance environment.

关 键 词：国家医保接口 先诊疗后结算 一次挂号一次结算 市域级信用体系 优化流程 

分 类 号：R197.32[医药卫生—卫生事业管理]