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KMID : 0379920000250020073
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Journal of The Korea Socity of Health Informatics and Statistics
2000 Volume.25 No. 2 p.73 ~ p.85
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The Study of Improvement Proposal in Computerization Request of Healing Cost
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Yu In-Sook
Kim Yoon-Shin
Choi Eun-Me
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Abstract
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he frequency of requesting at medical insurance has increased by 20 percent every year since Medical Insurance for al nation started in 1989. Which cause to increase requests of healing cost and examination works rapidly in related athorities. It was inevitable to improve the request method of medical facilities and computerize the works of examination athorities. In 1994 , Korea telecom started to develope MEDICOM and EDI system using its own system called EDI. EDI stands for electronic data interchange by which the related works of request examination and provision are processed over network. It is a motive of my study that find out some improvement of healing cost request to complement problems in medical center adapting EDI system.
The conclusions of this study are ;
Ⅰ. The preferance of EDI are shortening of provision period (29.1%), convenience of deduction analysis (27.3%), simplification of request work (16.4%). The fast provision of healing cost make interest higher. The automation of deduction analysis make the process time shot and easy.
Ⅱ. The problems of EDI request and improvement works ;
Ⅰ) Back data and asking the sent materials must be improved at first because of medical facilities duplicate works and financial problems brought out by delayed provision term.
Ⅱ) The deduction rate was said to be high (54.5%). That was highest between 1st yearand 2nd year (40% of respondents). Among the items, The cost of medicine, imported materials and healing materials used with no declaration have been deducted (F deduction).
Ⅲ) For the reference, All respondents say that current 350 bytes are so small that they must have other output, so reference room need increasing or to be infinite.
Ⅳ) Most difficult work in EDI system is matching between standard code and private code(42.7%) so need to be more simple and easy program to use.
Ⅴ) Communication cost is around \1million is documentary request but the cost using EDI is around \2million a month in the 3rd facilities. The respondents think that the adequate cost is around \1million to \1.5million. Besides, there must be repayment rules for communication troubles(92.7%) and the security of personal imformation (87.3%).
Ⅵ) The objection for maintaining inspection is high (66.4)% after using EDI system. The reason is that EDI request can be examined and analyzed in detail by estination authority. Besides, medical athorities can analyze the result of examination and applications of different view automatically.
Ⅶ) There are preference and improvement items in the provision term shortening of healing cost which makes interest high and cash flow good. Which represents that EDI request term might be variety according to medical authorities hospital treatment, outpatients or adapt all times request.
Ⅲ. Improvement items in EDI request of healing cost ;
Ⅰ) EDI request examination and errors in sending or receiving must have been improved to be processed in Dos and Window environment by the company which supplied S/W.
Ⅱ) Most respondents say there are average grades in all items which are the confirmation procedure of examination result documents, information inquiry procedure, request procedure, code change procedure, code matching works, the declaration procedure of materials and medicine.
Ⅲ) Improvement degree (percentage) for EDI extension. How much percentage improvement do they need? Variable EDI standard message virsion supply (42.7%) Conversion works, shortening the time of sending and receiving (45.5%) Convenience of correcting errors (44.5%), The reliance of documents and appended datum (48.2%) Stability of sending and receiving (44.5%), Reduction of communication cost(40.9%). Ease of using EDI (44.5%).
All items need improving much. By means of this result, new tools of standardization should be developed to make EDI standardization. In this study, we know that EDI will be more stable and more efficient when the problems are improved. which will affect medical authorities to attend with using EDI system.
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KEYWORD
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Electronic Data Interchange, Medical EDI Communication
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FullTexts / Linksout information
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