醫(yī)保與醫(yī)院信息管理系統(tǒng)接口軟件的探討

1、醫(yī)保與醫(yī)院信息管理系統(tǒng)接口軟件的探討摘要廈門醫(yī)療保險信息管理系統(tǒng)是以城域網(wǎng)為主十的大型計算機(jī)管理系統(tǒng)，已正 常運(yùn)轉(zhuǎn)了兩年。作為醫(yī)療保險定點醫(yī)療機(jī)構(gòu)上網(wǎng)的有51所，其中，全部三級醫(yī) 院和大部分二級醫(yī)院已開發(fā)應(yīng)用信息系統(tǒng)。因此，醫(yī)保系統(tǒng)與醫(yī)院系統(tǒng)的接口問 題必須得到解決。接口軟件必須達(dá)到3個要求：醫(yī)療消費數(shù)據(jù)的唯一性、醫(yī)保系 統(tǒng)的安全性、高效快速的性能。醫(yī)保系統(tǒng)與醫(yī)院系統(tǒng)的接口采用3種方案：無縫、 數(shù)據(jù)掃描、數(shù)據(jù)包交換。通過這3種方案，較好地解決了接口問題。關(guān)鍵詞：醫(yī)療保險；醫(yī)院信息系統(tǒng)廈門職工醫(yī)療保險信息管理系統(tǒng)（以下簡稱醫(yī)保系統(tǒng)）于1997年7月1日正 式啟動運(yùn)行，到目前已正常運(yùn)轉(zhuǎn)了兩年，狀況

2、良好。作為廈門市醫(yī)療保險定點醫(yī) 療機(jī)構(gòu)上網(wǎng)的醫(yī)院、門診部和廠礦企業(yè)衛(wèi)生所有51所，聯(lián)網(wǎng)計算機(jī)已達(dá)到200 臺，每天與醫(yī)療機(jī)構(gòu)發(fā)生交易量2萬多筆，并且系統(tǒng)正在按計劃繼續(xù)擴(kuò)大規(guī)模。醫(yī)院信息管理系統(tǒng)（以下簡稱醫(yī)院系統(tǒng)）是現(xiàn)代化醫(yī)院必不可少的基礎(chǔ)設(shè)施 與技術(shù)支撐環(huán)境，隨著信息社會的到來，醫(yī)院管理信息化正成為整個醫(yī)療行業(yè)的 發(fā)展趨勢。我市全部三級醫(yī)院和大部分二級醫(yī)院已開發(fā)應(yīng)用醫(yī)院信息管理系統(tǒng)， 不僅提高了醫(yī)院的綜合管理水平，而且為患者提供良好的服務(wù)環(huán)境；并在實際工 作中產(chǎn)生良好的經(jīng)濟(jì)效益和社會效益。在全國全面實行醫(yī)療保險制度的今天，如 何將相對獨立的醫(yī)保系統(tǒng)和醫(yī)院系統(tǒng)有機(jī)的結(jié)合在一起，使之既符合醫(yī)療保險

3、的 需求，又適合醫(yī)院的實際情況，是擺在我國醫(yī)保和醫(yī)院管理者面前的實際問題。 我們認(rèn)為解決這一問題，不單單是軟件開發(fā)人員的事，更是管理者必須提高全局 意識，全盤統(tǒng)籌規(guī)劃協(xié)調(diào)，下大決心解決的重大問題。一、廈門市醫(yī)保系統(tǒng)簡介廈門醫(yī)保系統(tǒng)是一套以IC卡為載體，以城域網(wǎng)為主十，以現(xiàn)代化通訊方式 為網(wǎng)絡(luò)聯(lián)通手段，以客戶機(jī)服務(wù)器模式為系統(tǒng)結(jié)構(gòu)的大型計算機(jī)管理系統(tǒng)。服務(wù) 器采用兩臺DEC Alpha4000小型機(jī)，一臺主服務(wù)器，一臺輔服務(wù)器，采用集群技 術(shù)，兩臺小型機(jī)共享一個磁盤陣列，陣列采用Raid0、1、5技術(shù)。小型機(jī)安裝 Digital UNIX,ORACIE7.3.2。整個網(wǎng)絡(luò)采用TCP/IP協(xié)議作為

4、網(wǎng)絡(luò)互連協(xié)議。 DECHUB900作為中心交換機(jī)完成中心局域網(wǎng)的設(shè)備連接。遠(yuǎn)程網(wǎng)經(jīng)中心路由器通 過64Kbps的DDN專線與醫(yī)院端路由器相連。另外是利用普通電話網(wǎng)以撥號方式 進(jìn)入中心與服務(wù)器相連。它既作為大型醫(yī)院的備用線路，也作為小型醫(yī)院主要上 網(wǎng)方式。系統(tǒng)的IC卡不僅起到身份標(biāo)識作用，還記載有大量信息，包括個人基 本情況和個人消費情況。二、廈門市醫(yī)院信息管理系統(tǒng)現(xiàn)狀目前，廈門市醫(yī)療機(jī)構(gòu)的醫(yī)院信息管理系統(tǒng)，既有采用以客戶機(jī)/服務(wù)器模 式、大型數(shù)據(jù)庫（如ORACLE、SQLSERVER）等當(dāng)今最新計算機(jī)技術(shù)，也有在DOS平 臺采用NETWARE，F(xiàn)OXPRO開發(fā)的小型數(shù)據(jù)庫管理系統(tǒng)。廈門市現(xiàn)有4

5、所三級醫(yī)院和5所二級醫(yī)院已經(jīng)開發(fā)應(yīng)用了醫(yī)院掛號劃價收費 管理系統(tǒng)，還有大部分醫(yī)院尚未開發(fā)應(yīng)用。已開發(fā)應(yīng)用的醫(yī)療機(jī)構(gòu)，其系統(tǒng)是由 多所軟件公司開發(fā)，各系統(tǒng)在開發(fā)平臺和開發(fā)工具等諸多方面不統(tǒng)一。以上這些， 反映了廈門市醫(yī)療機(jī)構(gòu)在應(yīng)用醫(yī)院信息管理系統(tǒng)的工作上，在應(yīng)用層次上有差 異，在相應(yīng)層次上的應(yīng)用水平也很不一致，這種應(yīng)用發(fā)展的不平衡狀況，直接影 響醫(yī)保系統(tǒng)與現(xiàn)有醫(yī)院系統(tǒng)的結(jié)合，也同時加大了醫(yī)保系統(tǒng)與醫(yī)院系統(tǒng)開發(fā)的工 作難度和工作量。三、廈門醫(yī)保系統(tǒng)與醫(yī)院系統(tǒng)的接口分析廈門市醫(yī)保系統(tǒng)提供醫(yī)院前臺收費軟件，通過該收費軟件將醫(yī)保病人的消費 數(shù)據(jù)實時傳送到醫(yī)保中心的主機(jī)系統(tǒng)存儲，這些消費記錄既作為醫(yī)保病人

6、的消費 數(shù)據(jù)記錄，也是醫(yī)保中心與醫(yī)院進(jìn)行財務(wù)結(jié)算的重要依據(jù)。醫(yī)院收費系統(tǒng)通過IC卡讀卡器讀出個人IC卡號等信息數(shù)據(jù)送往醫(yī)保系統(tǒng)確 認(rèn)，醫(yī)保系統(tǒng)返回個人基本信息，醫(yī)院收費系統(tǒng)據(jù)此進(jìn)行掛號、住院登記及收費； 醫(yī)院收費系統(tǒng)需將收費明細(xì)項目金額傳送給醫(yī)保系統(tǒng)，醫(yī)保系統(tǒng)根據(jù)醫(yī)保政策及 病人的基本信息，計算出3段付費金額，即個人帳戶支付金額、個人現(xiàn)金支付金 額及統(tǒng)籌基金支付金額，并將其返回給醫(yī)院收費系統(tǒng)，醫(yī)院收費系統(tǒng)據(jù)此打印發(fā) 票并寫入IC卡。由于廈門市醫(yī)療機(jī)構(gòu)的醫(yī)院信息管理系統(tǒng)應(yīng)用水平發(fā)展的不平衡，我們在醫(yī) 保最初的應(yīng)用前臺收費系統(tǒng)并未包含劃價收費功能，其劃價收費由各所醫(yī)院按照 現(xiàn)行辦法運(yùn)行。這樣，已有

7、劃價收費系統(tǒng)的醫(yī)院就必然地要求為醫(yī)保前臺收費軟 件與醫(yī)院現(xiàn)有劃價收費軟件提供一個高效快速的接口。四、廈門醫(yī)保系統(tǒng)與醫(yī)院系統(tǒng)的接口要求廈門市醫(yī)保系統(tǒng)是一個全新的應(yīng)用系統(tǒng)，其高平臺、先進(jìn)的實時性、更高的 安全性，使得所設(shè)計的與醫(yī)院管理系統(tǒng)的接口軟件必須達(dá)到以下幾個具體要求。醫(yī)療消費數(shù)據(jù)的唯一性：醫(yī)保患者的醫(yī)療消費數(shù)據(jù)要求一致，這是醫(yī)保系統(tǒng)與 醫(yī)院系統(tǒng)接口的最基本要求。醫(yī)院的收費劃價管理系統(tǒng)將個人處方劃價結(jié)果數(shù)據(jù) 除登記在醫(yī)院管理系統(tǒng)，還必需按照醫(yī)保中心的要求登記在醫(yī)保中心的主機(jī)系統(tǒng) 中，這就要求在兩個相對獨立的系統(tǒng)中，醫(yī)保病人的消費記錄保持一致，都來自 醫(yī)院的收費劃價系統(tǒng)，確保數(shù)據(jù)的唯一性。醫(yī)保系

8、統(tǒng)的安全性：醫(yī)保中心系統(tǒng)的主機(jī)存放幾十萬參保人員的基本檔 案、個人帳戶和統(tǒng)籌基金、個人和單位帳目等多方面數(shù)據(jù)，關(guān)系到幾十萬參保人 員的切身利益，其數(shù)據(jù)要求高度安全。因此，醫(yī)保系統(tǒng)不能完全對醫(yī)院系統(tǒng)開放。 任何醫(yī)院管理系統(tǒng)要求與醫(yī)保系統(tǒng)連接，其接口方案必須經(jīng)醫(yī)保中心審核，在保 證醫(yī)保系統(tǒng)安全的前提下，做好接口工作。高效快速的性能：醫(yī)院系統(tǒng)與醫(yī)保系統(tǒng)連接，其接口軟件要求高效快速， 對現(xiàn)有系統(tǒng)的速度影響減到最低程度，以縮短操作時間及病人等待時間。五、廈門醫(yī)保系統(tǒng)與醫(yī)院系統(tǒng)的接口方案目前，廈門市醫(yī)保系統(tǒng)與醫(yī)院系統(tǒng)的接口采用以下3種實施方案。無縫接口：計劃開發(fā)醫(yī)院信息管理系統(tǒng)的醫(yī)療機(jī)構(gòu)，在設(shè)計功能等各方

9、面 達(dá)到醫(yī)院要求的前提下，選擇開發(fā)醫(yī)保系統(tǒng)的軟件公司。由該軟件公司開發(fā)的醫(yī) 院系統(tǒng)在保證醫(yī)保系統(tǒng)安全的前提下，可直接訪問醫(yī)保系統(tǒng)主機(jī)，實現(xiàn)無縫接口， 即醫(yī)保系統(tǒng)與醫(yī)院系統(tǒng)的一體化。此種方式最為理想，既符合醫(yī)保需求，又適應(yīng) 醫(yī)院的實際情況；既保證了安全性，又實現(xiàn)高效快速。廈門市已有2所三級醫(yī)院、 2所二級醫(yī)院選用此方案，減少了中間環(huán)節(jié)，大大節(jié)省了投資，并已達(dá)到較理想 的效果。數(shù)據(jù)掃描接口：將醫(yī)院具有劃價功能的收費軟件產(chǎn)生的結(jié)果傳送到醫(yī)保系 統(tǒng)要求輸入劃價結(jié)果的窗口中，并要求對應(yīng)的收費欄目數(shù)據(jù)統(tǒng)一，有關(guān)醫(yī)院已開 發(fā)了屏幕或鍵盤緩沖區(qū)數(shù)據(jù)掃描和接收功能，很好地解決了接口問題，其主要特 點是在一臺機(jī)上

10、同時運(yùn)行兩套軟件，醫(yī)保系統(tǒng)處于收費狀態(tài)時由醫(yī)院收費劃價系 統(tǒng)發(fā)送劃價結(jié)果，醫(yī)保系統(tǒng)正確接收到數(shù)據(jù)后可依序操作，這樣，在不修改醫(yī)保 系統(tǒng)收費模塊的前提下實現(xiàn)兩個系統(tǒng)的數(shù)據(jù)接口，既保證了醫(yī)保系統(tǒng)的安全，也 共享了醫(yī)院的信息資源。數(shù)據(jù)包交換接口：采用數(shù)據(jù)包交換方案，即醫(yī)保系統(tǒng)把相關(guān)信息存儲在一 個數(shù)據(jù)包中供醫(yī)院劃價系統(tǒng)讀取，醫(yī)院劃價系統(tǒng)處理完的收費信息也存儲在一個 數(shù)據(jù)包中供醫(yī)保系統(tǒng)使用，以數(shù)據(jù)包交換的方式實現(xiàn)數(shù)據(jù)接口。廈門市醫(yī)保系統(tǒng)經(jīng)過兩年的探索和實踐，通過制定相關(guān)的管理措施，密切與 醫(yī)療機(jī)構(gòu)協(xié)作，以盡力保護(hù)醫(yī)院現(xiàn)有管理系統(tǒng)投資為原則，較好地解決了醫(yī)保系 統(tǒng)與醫(yī)院系統(tǒng)的接口問題。然而，隨著醫(yī)療保險

11、業(yè)務(wù)、計算機(jī)技術(shù)、通信技術(shù)及 醫(yī)療信息技術(shù)的迅猛發(fā)展，有些起點低、技術(shù)落后的醫(yī)院系統(tǒng)已暴露出嚴(yán)重缺陷， 既不能滿足醫(yī)保的需要，又阻礙醫(yī)院系統(tǒng)的進(jìn)一步發(fā)展，勢將被逐步淘汰。以地 （市）為統(tǒng)籌單位，其所在地（市）各個定點醫(yī)療機(jī)構(gòu)，應(yīng)在醫(yī)保管理部門和衛(wèi)生 主管部門的共同努力下，逐步建立起一套與醫(yī)保系統(tǒng)融為一體的、統(tǒng)一的醫(yī)院信 息系統(tǒng)，走向規(guī)范化、標(biāo)準(zhǔn)化；既減少重復(fù)開發(fā)和重復(fù)投資，又可降低軟件和硬 件的開發(fā)成本和開發(fā)周期；既可以與國家“金衛(wèi)工程”連接，又可以使醫(yī)院之間 聯(lián)網(wǎng)而共享信息資源?？傊?，順利解決醫(yī)保系統(tǒng)與醫(yī)院系統(tǒng)接口問題，必將有益 于正在全國各地開展的醫(yī)療保險工作。我院是鐵道部唯一指定的醫(yī)療保

12、險制度（以下簡稱醫(yī)保）試點醫(yī)院，1997年 我們研制了適應(yīng)醫(yī)保制度的醫(yī)院信息管理系統(tǒng)，運(yùn)行一年多來，性能穩(wěn)定。一、醫(yī)保方案我們采用“三通道”的醫(yī)保方案，即分為個人帳戶、隔離帶、統(tǒng)籌金3個收 費段。個人交納的年收入的1%與單位交納的人均年收入的8%的40%一起入到個 人帳戶，門診和住院交費超出個人帳戶后進(jìn)入隔離帶，隔離帶用完后即進(jìn)入統(tǒng)籌 金，由單位和個人分擔(dān)不同的比例?，F(xiàn)已發(fā)醫(yī)療保險IC卡89 900張，其中在職 職工卡69 829張、退休職工卡18 979張，離休職工卡1 092張，基本實現(xiàn)了 職工持卡看病，不必再墊付醫(yī)藥費。二、網(wǎng)絡(luò)環(huán)境服務(wù)器采用IBM PC Server 315操作系統(tǒng)為W

13、indows NT，并采用雙機(jī)熱 備份，與Raid 5磁盤陣列相連，以確保數(shù)據(jù)的安全性和可靠性。服務(wù)器硬盤容 量為2GB，24小時運(yùn)行?？蛻舳瞬捎肐BM 300GL，操作系統(tǒng)為Windows95。數(shù)據(jù)庫系統(tǒng)選擇了 Informix Dynamic 7.22,充分利用其穩(wěn)定性、可靠性、可伸縮性和先進(jìn)性。采用以太網(wǎng)，通信協(xié)議為TCP/IPO醫(yī)院以DDN專線經(jīng)Cisco2511路由器與醫(yī)保與中心進(jìn)行數(shù)據(jù)交換。計算機(jī)配備：住院處配備3臺工作機(jī)，負(fù)責(zé)門診、急診掛號與辦理住院手 續(xù)；負(fù)責(zé)患者醫(yī)藥費用查詢。收費處配備8臺工作機(jī)，其中4臺負(fù)責(zé)醫(yī)囑錄入， 4臺負(fù)責(zé)門診、急診收費與辦理出院結(jié)算手續(xù)。中藥房配備1臺

14、工作機(jī)，西藥房 配備2臺工作機(jī)，負(fù)責(zé)處方的確認(rèn)與發(fā)藥。計算機(jī)室配備2臺服務(wù)器，1臺網(wǎng)管 機(jī)。藥庫、財務(wù)科、院長辦公室各配備1臺工作機(jī)。三、系統(tǒng)功能本系統(tǒng)包括10個子系統(tǒng)。掛號子系統(tǒng)：包括掛號作業(yè)、掛號查詢、掛號結(jié)帳、掛號統(tǒng)計。門急診收費子系統(tǒng)：包括錄方劃價計費、退方處理、處方查詢、結(jié)賬、費 用統(tǒng)計、門診醫(yī)療費結(jié)算清單、路外醫(yī)療費結(jié)算清單。住院管理子系統(tǒng)：包括入院登記、醫(yī)囑管理、預(yù)交金管理、床位管理、轉(zhuǎn) 科處理、病案首頁、出院結(jié)算、統(tǒng)計。藥房管理子系統(tǒng)：包括初始化錄入、初始化盤存、藥房出藥、損耗登記、 藥房發(fā)藥、處方查詢、入藥情況、出藥情況和初始化情況查詢，剩余量查詢，盤 存查詢。藥庫管理子系統(tǒng)

15、：包括出入庫操作、出入庫校驗、出入庫查詢、藥典維護(hù)、 藥庫盤點、藥房缺藥查詢、藥庫計劃等。院長查詢子系統(tǒng)：門急診掛號信息、住院信息、藥庫藥房信息、綜合信息。財物管理子系統(tǒng)：匯總信息、日常事物（收款員交帳與交賬查詢等）、常用 財務(wù)報表（各科室路內(nèi)收入一覽表、醫(yī)療統(tǒng)籌金清算表、住院醫(yī)療費結(jié)算清單等）。字典維護(hù)子系統(tǒng)：包括科室編碼字典維護(hù)、錄入員與醫(yī)師信息字典維護(hù)、 處置優(yōu)惠與處置編碼字典維護(hù)、病床信息字典維護(hù)、藥典維護(hù)、門診急診與專家 掛號字典維護(hù)、系統(tǒng)功能維護(hù)。數(shù)據(jù)傳輸子系統(tǒng)：與醫(yī)保中心進(jìn)行數(shù)據(jù)傳輸。患者費用查詢子系統(tǒng)：IC卡金額查詢、住院部出院費用查詢、住院部在 院費用查詢、門診費用查詢。四、

16、系統(tǒng)特點標(biāo)準(zhǔn)化：遵從國家有關(guān)醫(yī)保政策的標(biāo)準(zhǔn)和規(guī)范，標(biāo)準(zhǔn)的數(shù)據(jù)庫結(jié)構(gòu)與數(shù)據(jù) 字典，統(tǒng)一的數(shù)據(jù)交換格式。開放性：本系統(tǒng)從系統(tǒng)軟硬平臺到應(yīng)用程序均采用開放結(jié)構(gòu)，對今后系統(tǒng) 升級和對應(yīng)用軟件的二次開發(fā)提供了充分的保證。高效性：醫(yī)院客戶端以IC卡為個人信息載體，電子劃價為基礎(chǔ)，實現(xiàn)高 速收費，減少病人就診排隊的等待時間。安全性：系統(tǒng)采用了 IC卡、讀卡機(jī)及數(shù)據(jù)庫存3部分連鎖加密，IC卡分 卡加密及DES數(shù)據(jù)加密算法，極大的保證了數(shù)據(jù)的安全性。靈活性：醫(yī)保方案有一個逐漸完善的過程，為了增加系統(tǒng)的靈活性，該系 統(tǒng)設(shè)計中采用了軟件參數(shù)相分離的方式，不同的醫(yī)保方案、不同政策優(yōu)惠比例系 數(shù)及金額的界定，只需通過在

17、數(shù)據(jù)字典中靈活配置參數(shù)即可實現(xiàn)，而無須修改程 序。五、應(yīng)用體會系統(tǒng)的應(yīng)用強(qiáng)化了門診掛號、診療、劃價收費管理，住院病人根據(jù)醫(yī)囑自動 結(jié)帳，堵塞了人為造成的收費漏洞，增加了醫(yī)院的合理收入，提高了醫(yī)院的經(jīng)濟(jì) 管理水平。加強(qiáng)了藥品價格管理，由于收費處與藥存相連，保證了藥品價格的及 時調(diào)整。我院多年來一直未能解決就醫(yī)不掛號問題，現(xiàn)在患者不掛號，IC卡就 不能用，就不能取藥或處置，因此患者也行成了首先自動掛號的習(xí)慣，為醫(yī)院帶 來了經(jīng)濟(jì)收益。系統(tǒng)設(shè)置了催款程序，促使病人盡快續(xù)交費用，控制了欠費現(xiàn)象。 患者辦理住院手續(xù)時，將IC卡留在收費處，避免了病人不結(jié)帳就出院溜走的現(xiàn) 象。系統(tǒng)可為管理者提供準(zhǔn)確信息。通過

18、“院長查詢子系統(tǒng)”可以看到有關(guān)部門 的運(yùn)行情況，并且可以對不同時期的指標(biāo)作對比。我院自1999年開始實行成本 核算，從計算機(jī)系統(tǒng)可及時準(zhǔn)確地調(diào)出各醫(yī)療、醫(yī)技科室的工作量，計算出各科 的收入情況。計算機(jī)網(wǎng)絡(luò)為患者提供了監(jiān)督條件。住院處設(shè)有查詢機(jī)，患者可對 各項費用進(jìn)行查詢，提高了患者對醫(yī)院的信任度。4月22日，金衛(wèi)醫(yī)保信息管理（中國）有限公司在上海宣告成立,做為中國首家 專業(yè)從事醫(yī)療保險信息管理及醫(yī)療保險服務(wù)外包的技術(shù)先進(jìn)型企業(yè)，金衛(wèi)醫(yī)保搶 灘上海，并在世博會開幕前夕揭牌，意味著從是日起，在境外投保的來華人士，可 以在中國的醫(yī)院使用醫(yī)療保險就醫(yī)。金衛(wèi)醫(yī)保系由在香港上市的金衛(wèi)醫(yī)療集團(tuán)與美國著名的政

19、府醫(yī)保管理公司 SynerMed和EHS組建的合資公司，公司注冊資本金五千萬美元。金衛(wèi)醫(yī)療擁有金 衛(wèi)醫(yī)保70%權(quán)益。集團(tuán)主席兼金衛(wèi)醫(yī)保董事局主席甘源在媒體交流時表示，做為有效連接國內(nèi) 外醫(yī)療保險公司、醫(yī)院和投保人三方的橋梁和紐帶，金衛(wèi)醫(yī)保公司的成立不僅填 補(bǔ)了國內(nèi)相關(guān)行業(yè)發(fā)展的空白，滿足大量來華工作和旅游的境外人士日益增長的 醫(yī)療服務(wù)和醫(yī)療保障的需求，亦能為促進(jìn)中國旅游醫(yī)療事業(yè)的發(fā)展創(chuàng)造基本條 件。金衛(wèi)醫(yī)保執(zhí)行董事兼CEO經(jīng)建中介紹，身為國內(nèi)第一家醫(yī)療保險第三方服務(wù) 機(jī)構(gòu)，目前已有30多家大型跨國商業(yè)保險公司與金衛(wèi)醫(yī)保簽約。公司的運(yùn)行，將 帶來多贏局面：首先，外籍人士來華就醫(yī)更為方便、有了更多

20、選擇。因有效解決了支付問題, 將為旅游醫(yī)療創(chuàng)造一個最必要的條件；其次，國外幾十個保險公司與金衛(wèi)醫(yī)保合作，可以建議投保人在中國醫(yī)院就 醫(yī)，實現(xiàn)像在本國一樣，用保險卡支付，這樣便為醫(yī)院帶來賺取利潤的機(jī)會；第三,對保險公司降低成本、規(guī)避風(fēng)險可起到很好的作用。經(jīng)建中表示，這項業(yè)務(wù)的合作醫(yī)院，目前主選大的城市，即外國人居住、工作、 旅游較多的城市大三甲醫(yī)院，其VIP、特需區(qū)、國際部是主要合作對象。在上海, 這樣的點有60個左右。他透露，依托金衛(wèi)醫(yī)療集團(tuán)在中國廣泛的醫(yī)院網(wǎng)絡(luò)資源、美方合作伙伴多年 服務(wù)管理美國政府醫(yī)療保險（Medicare）的經(jīng)驗和自建的智能化專有網(wǎng)絡(luò)系統(tǒng)和 軟件平臺，金衛(wèi)醫(yī)保能夠為海內(nèi)外

21、醫(yī)療保險公司和其他相關(guān)機(jī)構(gòu)提供專業(yè)化、可 定制、精準(zhǔn)的后臺服務(wù);協(xié)助保險公司降低經(jīng)營風(fēng)險和運(yùn)營成本，支持其實現(xiàn)產(chǎn)品 創(chuàng)新；同時亦能推動醫(yī)療保險產(chǎn)業(yè)與醫(yī)療臨床服務(wù)的有機(jī)結(jié)合，并帶動商業(yè)補(bǔ)充 醫(yī)療保險的健康發(fā)展。他著重指出，作為一家創(chuàng)新的、獨立第三方醫(yī)保外包服務(wù)企業(yè),金衛(wèi)醫(yī)保的成 立，符合當(dāng)前國內(nèi)外醫(yī)療保險行業(yè)將后臺業(yè)務(wù)外包日漸加速的趨勢。Medical insurance and hospital information management system interface software ofInvestigateABSTRACTXiamens medical insurance inf

22、ormation management system, a large-scale computer management system with city network as its mainstay, has been functioning normally for 2 years. 51 of the medical institutions designated for medical insurance have joined the network. Among them, all of the first-grade and most of the second-grade

23、hospitals have made use of the information management system. Thus the problem of interfacing of softwares for medical insurance and hospital information management systems and the hospital administration system must be solved. Interface softwares must meet 3 requirements: uniqueness of medical cons

24、umption data, security of medical insurance information management system and high efficiency and speed. The issue has been fairly well solved through the adoption of 3 measures: seamless structure, data scanning and packet exchange.Key Words: Medical insurance; Hospital information systemXiamen, me

25、dical insurance information management system (hereinafter referred to as medical insurance system) on July 1, 1997 officially started operation to normal operation now for two years, in good condition. Xiamen City, as designated medical institutions, medical insurance, access hospitals, health clin

26、ics and industrial enterprises of all 51, the computer network has reached 200 per day trading volume occurred with the medical institutions more than 20,000 pen, and the system is planned to expand the scale of .Hospital Information Management System (hereinafter referred to as the hospital system)

27、 is essential for modern hospital infrastructure and technical support environment, with the advent of the information society, the hospital management information is becoming the development trend of the entire medical industry. All three city hospitals and two hospitals have been development and a

28、pplication of most of the hospital information management system not only improves the level of integrated management of the hospital, but also provide good services for the patient environment; and in actual work to produce good economic and social benefits. The full implementation of the national

29、health insurance system, how will independent medical insurance system and hospital system combines organic, enabling it to meet the demand for health insurance, but also the actual situation for the hospital, is placed in our medical insurance and hospital management practical problems in front. We

30、 believe that to solve this problem, not just software developers, but also a need to improve the overall awareness of managers, co-ordinate the overall planning and coordination, be determined to solve the major problem.First, Introduction Xiamen Medicare.Xiamen health insurance system is a set of

31、IC cards as the carrier, metro backbone, with modern means of communications for the network Unicom to client-server model for the system structure of large computer management system. Server with two DEC Alpha4000 minicomputer, a main server, a secondary server, using clustering technology, two sma

32、ll machines to share a disk array, array with Raid0, 1,5 technology. Minicomputer installs Digital UNIX, ORACIE7.3.2. Entire network using TCP / IP protocol as a network interconnection agreement. DECHUB900 completed as a central switching center LAN device. The center of the remote network router v

33、ia the DDN 64Kbps line client router connected to the hospital. Another is the use of ordinary telephone network to dial into the center and the server is connected. Its back-line as a large hospital, but also as the main access way for small hospitals. IC card system not only plays the role of iden

34、tity, but also records a large amount of information, including basic personal circumstances and personal consumption.Second, Xiamen City Hospital Information Management System Status.At present, Xiamen City, the hospital medical information management system, both adopt a client / server model, a l

35、arge database (such as ORACLE, SQLSERVER) so todays latest computer technology, also used in the DOS platform, NETWARE, FOXPRO database management system developed by a small .Xiamen available in 4 hospitals and five secondary hospitals have been designated development and application of the price c

36、harged by registered hospital management system, as well as most hospitals have not yet developed applications. Development and application of medical institutions has been their system is more than software developed by the various system platforms and development tools in the development of many a

37、spects such as non-uniform. These reflect the Xiamen Municipal Hospital medical institutions in the application of information management systems work, there are differences in the application level, application level in the corresponding levels are inconsistent, the imbalance in the development of

38、this application, directly affect the health insurance system integration with existing hospital systems, health insurance system also increased the work of the hospital system development difficulty and workload.Third, Xiamen medical insurance system and hospital system interface analysis. Xiamen M

39、unicipal Hospital medical insurance system charges the software front, the adoption of the Medicare patients and charging software will transmit real-time consumption data to the Insurance Center of host system memory, which records both as a health insurance consumer consumption of data records of

40、patients, healthcare centers and hospitals is also a financial settlement an important basis.Hospital payment system through the IC card reader to read out personal information such as data sent to the IC card number to confirm medical insurance system, medical insurance system back to basic persona

41、l information, payment system whereby hospitals were registered, hospital registration and fees; hospital billing systems to charge the amount of detail the project to send medical insurance system, medical insurance system, medical insurance policy and under the patients basic information, pay the

42、amount calculated in paragraph 3, that personal account to pay the amount of personal cash payments and co-ordinate fund payments, and return to the hospital charges system, hospital payment system according to print invoices and write IC cards.As medical institutions Xiamen Hospital Information Man

43、agement System application level uneven development, the application of our first front in the Medicare payment system does not include price plan charge function, and its designated price charged by the hospital to run under the existing approach. This has been designated payment system of hospital

44、 price is bound to ask for the health insurance front software fees and hospital charges price of existing software program to provide a rapid and efficient interface.Fourth, Xiamen medical insurance system and hospital system interface requirements. Xiamen is a new medical insurance system, applica

45、tion system, its high platform, the real-time advanced, more secure, so that designed the systems Joe Kou and hospital management software to the following Jigejuti Yao Qiu Da Dao.The uniqueness of health care consumption data: Medicare patients with the same data requirements of medical consumption

46、, which is medical insurance system and hospital system interface of the most basic requirements. Hospital management system will pay price plan prescription plan price personal data except the results registered in the hospital management system, also need to register in accordance with the require

47、ments of Medicare Centre center hosts in the health insurance system, which requires two relatively independent systems, Medicare patients consistent consumer records, all charges from the hospital designated price system to ensure that data is unique.Medicare System Security: Insurance Center syste

48、m host hundreds of thousands of insured deposit the basic records, personal accounts and social pool fund, accounts and other aspects of individuals and units of data related to the hundreds of thousands of insured personal interests of the high security of their data requirements. Therefore, the me

49、dical insurance system on the hospital system can not open. Any hospital management system requirements and medical insurance system is connected, its interface program must be reviewed by the Health Insurance Center, in ensuring the safety of medical insurance system under the premise of good inter

50、face to work.Rapid and efficient performance: the hospital system and medical insurance system is connected, its interface software requires high speed, the speed of impact on existing systems to minimize the extent to shorten the operation time and patient waiting time.Fifth, Xiamen medical insuran

51、ce system and hospital system interface program.At present, Xiamen City medical insurance system and hospital system interface using the following three kinds of implementation.Seamless interface: plans to develop the hospital information management system, medical institutions, and other aspects in

52、 the design of functional requirements to the hospital and the premise, select the health insurance system software development company. Software developed by the hospital system in ensuring the safety of medical insurance system under the premise of direct access to medical insurance system host, s

53、eamless interface, the medical insurance system and hospital system integration. In this way the best, consistent with Medicare requirements, but also to adapt to the actual situation of the hospital; not only guarantee security, but also to achieve fast and efficient. Xiamen has two tertiary hospit

54、als; two hospitals secondary use this program to reduce intermediate links, significant savings in investment, and has reached a more satisfactory results.Data scan interface: the hospital has a designated price it cost software result sent to the medical insurance system for the importation of desi

55、gnated price results window, and asked the corresponding fees and charges section of data unity, the hospital has developed a screen or keyboard buffer data scanning and receive functions, solves the interface problem, the main features on a single machine to run two sets of software at the same tim

56、e, state health insurance system in the fees charged by the hospital system Fazing planning plan price results, medical insurance system correctly received data Key Yi sequence operation, so that no changes in the health insurance system under the premise of charging module to achieve the two system

57、s of data interface, both to ensure the Medicare systems security, also shared the hospitals information resources.Data Packet Interface: The packet exchange program, the Medicare system, the related information is stored in a data package for hospital planning price system to read, the hospital des

58、ignated price system processed the charge information is also stored in a data package for the medical insurance system use to the way packets of data exchange interfaces.Xiamen health insurance system after two years of exploration and practice, through the development of related management measure

59、s, in close collaboration with medical institutions to try to protect the investment of existing hospital management system principles, can solve the health insurance system, the interface with the hospital system. However, as medical insurance, computer technology, communication technology and medi

60、cal information technology, the rapid development of some low starting point, technology behind the hospital system has revealed serious shortcomings as it neither satisfies medical insurance needs nor had the further development of hospital system Zuni is bound to be phased out. To (city) to the in