General plan
The resident information system consists of a multi-level business network of city-county-township-village, and adopts the principle of "centralized data and graded service". The whole system is divided into four business platforms: city, county, township and village. Data is concentrated in county-level data centers. The municipal platform is the same as the county data center, and all business platforms interact through the network.
The new rural cooperative medical system is an important part of the comprehensive information platform of the new rural cooperative medical system. According to the strategy of overall planning, sub-system, step-by-step implementation and overall integration, on the basis of establishing the database of rural cooperative medical center, health file data are also stored centrally, which lays a solid foundation for building a regional health information platform based on health files. Finally, by integrating the data of other health information systems, a distributed health information data warehouse with massive data resources is gradually formed for query, statistics and data analysis.
1 overall flow chart
The procurement office determines the procurement catalogue according to the basic catalogue of the new rural cooperative medical system, the village clinic reports the demand to the township hospitals, and the city and county hospitals and township hospitals report the summary demand; After unified procurement by the Procurement Office, the distribution center will deliver * * to cities and counties hospitals and township hospitals; Township hospitals implement integrated management of clinics and decentralize clinics;
Participating farmers are treated in county hospitals, township hospitals, village clinics and other designated medical institutions, and the compensation amount is automatically calculated by the system according to the reimbursement method at the time of settlement. Designated medical institutions conduct preliminary examination of medical expenses, and advance the funds that should be compensated according to the implementation plan. The medical expenses paid by the designated medical institutions shall be reported to the county (city, district) agencies for examination after passing the examination by the township (town) agencies, and the prepaid expenses shall be replenished to the designated medical institutions through the financial department or bank in time.
Data sharing of all systems, comprehensive supervision and management of relevant institutions, and networked and standardized supervision and management of the new rural cooperative medical system.
2 process analysis
2. 1 hospital reimbursement process
The business system of the new rural cooperative medical system provides a data interaction interface with the hospital HIS system. When calculating the compensation amount, hospitals that have used the HIS system can import detailed data of patients' visits through the interface, including * * expenses, medical expenses, hospitalization expenses, etc. If there is no HIS system, these detailed data must be manually entered one by one. At the same time, the whole process of supervision and management.
The combination of the business system of the new rural cooperative medical system and HIS system can realize the "direct subsidy" for patients' medical treatment, that is, after the patient's medical treatment, the compensation fee for the new rural cooperative medical system is directly calculated and deducted, and the patient only needs to pay the difference, and the relevant vouchers are submitted by the hospital to the staff of the joint management office.
System highlights:
1 to improve the settlement speed and accuracy. The business system of the new rural cooperative medical system directly reads the business data in the hospital HIS system, which reduces the workload of reimbursement entry and avoids the disadvantages of inaccurate entry caused by secondary entry.
2. Improve efficiency and simplify the reimbursement process. Realizing "direct reporting" saves the process of patients going to the joint management office to settle the compensation amount, saving patients' time;
3. Reduce the burden on patients. Reduce the amount paid directly by patients to the hospital, greatly reducing the burden on patients;
4. The data is safe and accurate. According to the data exchange with the new rural cooperative medical system, the hospital HIS locks the settled data in the HIS to avoid illegal operation.
2.2 Business process of village clinics
The integrated management of outpatient service provides conditions for unified procurement and distribution, and ensures the smooth progress of unified procurement and distribution. Village clinics report hospital needs and receive updated information and drug deployment data of integrated management; And send business data and rural cooperative reimbursement data to the health center. Realize the functions of instant reimbursement, queuing reimbursement, and locking the submission of documents when participating farmers see a doctor.
System highlights:
1, unified management, unified assessment, unified catalogue, unified distribution and unified price for outpatient personnel.
2. The outpatient management system and the new rural cooperative medical reimbursement system integration.
3. Outpatient reimbursement has queuing function, and it cannot be reimbursed without approval.
4, to ensure the quality of drug use at the grassroots level, so that the masses can use the rest assured drugs.
5. It's not that the release * * can't enter the integrated system (there is no entry window, so it can only be imported automatically).
2.3 Procurement and Distribution Process