Construction of medical insurance informatization supervision system based on failure mode and effect analysis
10.3760/cma.j.cn111325-20231215-00401
- VernacularTitle:基于失效模式与效应分析的医保信息化监管体系建设
- Author:
Hongyi ZHANG
1
;
Jiayi GUO
;
Yanhong HUANG
;
Jiecong YAO
;
Huifang QIAN
Author Information
1. 浙江大学医学院附属金华医院医保物价办公室，金华 321000
- Keywords:
Hospital information systems;
Diagnosis and treatment behavior;
Medical insurance supervision;
Failure mode and effect analysis
- From:
Chinese Journal of Hospital Administration
2024;40(7):529-534
- CountryChina
- Language:Chinese
-
Abstract:
In various types of inspections and self-inspections, it was found that compliance and rationalization in diagnosis and charging were the more common problems in hospital, leading to refusal of medical insurance payment. In 2022, the failure mode and effect analysis was conducted in a Grade-A tertiary hospital in Jinhua to identify the high-risk points in the process of diagnosis and treatment and charging, and building six major information technology transformation scenarios and formulating specific transformation measures, to avoid or reduce the refusal of medical insurance payment in advance. Through the digital transformation of medical insurance supervision system, a whole process intelligent supervision has been implemented, including pre event review, mid event reminder and intelligent correction, and post event big data precise analysis. It promoted compliant diagnosis and treatment of medical personnel and accurate charging, which could provide reference for other medical institutions to use medical insurance funds reasonably.
