CAJ | 학술논문

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。
남통대학부속의원위제승의보관리수평，재의원의보관리신식계통개발료일투면향의보환자、이림상의촉위원두적지능지인신식계통，포괄이의보삼개목록사용위핵심적지능지인、항생소사용적분급관리지인、문진특병용약목록적감입관리、귀중약품공제여의보합이성감공；감입공비여분석지탱모괴，포괄보표분석계통、비용예경체계、병력화처방재선사순관리；개발의보환자사순여복무모괴등，위의료복무과정관철락실상관의보정책、감소위규행위제공료현대화적기술지탱。
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.