健康险信息系统平台业务需求说明书V.doc
医疗保险系统需求规格说明书
医疗保险系统需求规格说明书2002年5月6日第一章引言 ................................................... 4 1.1目地 . (4)1.2范围 (4)1.3主要业务名词和术语 (4)1.4 参考文件 (5)第二章任务概述 (5)2.1系统描述 (5)2.2与其它系统关系 (6)2.3边界定义 (6)2.3.1系统覆盖的业务范围 (6)2.3.2系统功能边界 (6)2.3.2.1系统包括的管理和处理功能 (6)2.3.2.2系统不包括的管理和处理功能 (6)2.4业务规则 (6)2.4.1基本医疗保险 (6)2.4.2大病求助 (9)2.4.3公务员医疗补助 (9)2.4.4医疗费用结算 (11)2.5基本功能描述 (12)2.5.1征集业务子系统 (12)2.5.2 医疗保险帐户管理子系统 (16)2.5.3 定点医院医疗保险业务子系统 (16)2.5.4 定点药店医疗保险业务子系统 (16)2.5.5 劳动保障部门支付业务子系统 (16)2.5.6 系统维护及管理子系统 (16)第三章功能模型概述 (16)3.1中心支付子系统 (16)3.1.1特殊医疗审批 (17)3.1.1.1异地转诊审批表 (17)3.1.1.2器官移植和安装人工器官审批表 (17)3.1.2医疗费用报销 (18)3.1.2.1费用明细录入 (18)3.1.2.2费用结算 (19)3.1.2.3特殊报销 (19)3.1.2.4报销单打印 (19)3.1.2.5中心报销结算明细查询 (21)3.1.2.6中心报销结算情况统计 (21)3.1.2.7结算单打印 (21)3.1.2.8出院结算单打印 (22)3.1.2.9费用明细查询 (22)3.1.2.10个人密码设置 (22)3.1.2.11个人密码初始化 (23)3.1.3定点医院结算 (23)3.1.3.1定点医院报盘 (23)3.1.3.2定点医院月申报 (23)3.1.3.3定点医院月审核 (24)3.1.3.4定点医院月支付 (24)3.1.3.5定点医院年审核 (25)3.1.3.6定点医院年支付 (26)3.1.4定点药店结算 (26)3.1.4.1定点药店报盘 (27)3.1.4.2定点药店月申报 (27)3.1.4.3定点药店月审核 (27)3.1.4.4定点药店月支付 (28)3.1.4.5定点药店年审核 (28)3.1.4.6定点药店年支付 (29)3.1.5定点机构管理 (30)3.1.5.1基本信息维护 (30)3.1.6业务查询 (30)3.1.7基金情况统计 (31)3.1.8政策修订 (32)3.2医院门诊支付子系统 (33)3.3医疗保险住院结算系统 (39)3.3.1住院登记 (39)3.3.2押金管理 (40)3.3.3住院结算 (41)3.3.4综合查询 (44)3.3.5统计报表 (45)3.4医疗保险医院系统维护 (45)3.4.1门诊查询 (46)3.4.2住院查询 (47)3.4.3综合统计查询 (49)3.4.4中心报表 (50)3.4.5医疗审批 (50)3.4.6数据传输 (52)3.5医疗保险系统维护 (56)3.5.1操作员管理 (57)3.5.2系统模块维护 (58)3.5.3参数维护 (60)3.5.4设置 (60)3.6医疗保险财务管理子系统 (60)3.6.1基金征集 (60)3.7医疗保险证卡管理 (64)3.7.1发卡登记 (64)3.7.2证卡补办 (65)3.8基金征集子系统 (65)3.8.1 参保单位信息管理 (65)参保人员信息管理 ..... 错误！未定义书签。
XX市社区健康智管应用系统项目需求说明
XX市社区健康智管应用系统项目需求说明（一）项目需求说明及清单（二）一般要求1、项目实施周期：合同签订生效后9个月内完成社区健康智管应用开发工作，并投入整体试运行，系统整体试运行期3个月，试运行期结束后做整体验收。
2、计划方案：提供书面的项目实施方案与实施计划。
3、投标人应详细阅读招标文件的全部内容。
按照招标文件要求提交投标文件，并保证所提交的全部资料的真实性。
不按招标文件的要求提供的投标文件和资料，则被视为无效标而导致投标被拒绝。
4、中标人未按合同要求时间完成项目，每延误一天支付合同总价0.5%的违约金。
5、若投标人的最低投标价或者某些分项报价明显不合理或者低于成本，有可能影响诚信履约的，评标委员会可能做出取消该投标人中标资格。
6、所有软硬件设备支持ipv4∕ipv6双栈服务。
（三）实施进度、测试与验收1、投标人有责任检查安装现场是否符合产品安装条件。
2、要求在本项目建设合同签订之日起12个月内完成需求分析、系统改造、试运行、验收等工作。
3、投标人应承担投标软件的安装、测试和有关配置工作，进行实际的测试。
4、产品实施过程中，如果牵涉到与第三方产品集成工作，投标人应与其他相关单位通力合作，并提供必要的技术支持，免费完成接口开发工作。
5、系统验收合格的条件必须满足以下要求：5.1、试运行时功能满足合同要求；5.2、验收时试运行中出现的问题已被解决；5.3、出具具有软件测评资质的第三方软件测评公司的软件功能、性能测评报告与安全测评报告,评测费用由中标人承担；5.4、双方签字确认的需求变更单；6、投标人应在投标书中提供本次项目实施的实施人员名单，以及整个软件实施工期的具体计划安排表。
（四）采购需求及技术要求4.1.项目概况4.1.K建设背景近年来，卫生健康部门在信息化建设方面以卫生数据中心为核心，形成了包括以健康档案、健康XX和云影像等一系列应用。
但是对照数字化改革新要求，各项业务之间的整体性、协同性还不够，部门间“信息孤岛”和“烟囱林立”现象依然存在。
健康信息系统设计与实施指南说明书
The Design of Discharge Summary for Patients ofContinuous CareLaili Rahmatul Ilmi* Medical Record and HealthInformationUniversity of Jenderal Achmad YaniYogyakarta, Indonesia ORCID: 0000-0002-4402-8406Ide Redika Sayekti Medical Record and HealthInformationUniversity of Jenderal Achmad YaniYogyakarta, IndonesiaAbstract — The use of information systems and technology in the health sector improves performance. A discharge summary is designed in an interface that can improve the quality of medical data documentation, efficiency, easy access to health information, support sustainable health decision-makers, and provide protection for patients, doctors, and health facilities as well as an exchange of information between health care providers. The objective of this study is to improve the quality of medical resume documentation as a comprehensive communication tool and support continuity of care. This research method is to design a web-based discharge summary portal interface display with a research design & development method (R & D) with a qualitative approach. The subject of this research is a doctor who has a discharge summary and medical record staff with in-depth interviews. The next stage is to design a web-based discharge summary portal referring to accreditation items and user input, then the design results are presented to doctors, medical record officers and managers. The manual discharge summary become a reference for designing the user interface for the patient discharge summary portal and there are several additional menus, namely; admin chat services, prayers when sick, SOAP, and hospital maps. Keywords — design, interface, discharge summary, continuity of careI. I NTRODUCTIONThe use of information systems and technology in the health sector improves performance. A discharge summary is designed in the utilization of health technology and information not only improves service performance but is more effective, provides easy data access, accelerates decision making (1). Several previous studies have explained that the use of technology and health information has an impact on the economy, social, speed of medical data exchange, communication tools (2). The paradigm shift in organizing paper to electronic medical records is certainly not an easy thing, it takes more effort to equalize perceptions, of course, this change is balanced with the readiness of all parties (3). The implementation of electronic medical records certainly requires a proper design according to user input, this is aimed at making it easy to fill in so that the data filled in is complete and accurate (4) (5).The application of electronic medical records in integrated health services is of course very beneficial for doctors and other health workers to carry out communication and follow-up care (6). Researchers carried out initial identification of existing problems, PKU Muhammadiyah Bantul has implemented electronic medical records in outpatient services, but the utilization of discharge summaries has not been optimal. The researcher wants to optimize the use of electronic discharge summaries by designing a discharge summary portal through the stages of identifying initial requirements. At the identification stage, we conducted in-depth interviews with doctors filling in the discharge summary, then the researchers designed the discharge summary portal, discussed the design results and implementation.PKU Muhammadiyah Bantul Hospital uses a discharge summary to record patient health information so that services remain well integrated. In designing a web-based patient discharge summary portal, the authors obtained several things during the study:A. Identification of the patient'sDischarge summary at PKU Muhammadiyah Bantul Hospital consists of manual and electronic discharge summary contained in the hospital's electronic medical records. For electronic discharge summary not yet accessible to all users. Only nurses and doctors in polyclinics can access electronic discharge summary. The doctor records the patient's health information into electronic medical records on the discharge summary menu with limited data elements that adjust the manual discharge summary.B. Requirement for User Interface ElementsThe data elements contained in the electronic discharge summary contained in the hospital information system adjust the manual discharge summary that the hospital has set according to accreditation standards. However, the discharge summary portal itself adds several menus to complete the information on the patient's discharge summary. The addition of these elements has been considered according to the data needs of discharge summary portal users.C. Designing discharge summary Portal User Interface The menus discharge summary will be made simple and attractive to make users comfortable when using the web-based portal. The dominant use of green and Islamic themes further adds to the characteristics of the PKU MuhammadiyahBantul Hospital identity. Any data contained in the dischargeProceedings of the First International Conference on Social Science, Humanity,and Public Health (ICOSHIP 2020)Copyright © 2021 The Authors. Published by Atlantis Press SARLsummary portal will also be integrated with data in the hospital (Fig.1)Fig. 1.Concept of design interface for discharge summaryII.M ETHODThis was using a research & development method (R&D) research design with a qualitative approach. The initial identification stage of the researcher conducted interviews with 3 doctors who were willing to become informants and 3 medical record officers to find out the needs needed in designing the discharge summary portal. with a qualitative approach. The sample consisted who were selected after agree to be informants. Researchers used an interview guide to explore information on the need for electronic discharge summary design. After the interview, the researcher conducts the initial design as needed, then the stage 1 presentation is carried out. In the next stage, the researcher makes a presentation of the design results and adds features after getting input from the user. Interview data were analyzed in a structured manner through the coding, cleaning, transcript, and presentation stages of narrative data.III.RESULTSA.This was using a research & development method(R&D) research design Identification of the patient'smedical resume at PKU Muhammadiyah BantulHospital.The author wants to find out whether there is an electronic medical resume at PKU Muhammadiyah Bantul Hospital and whether it has been implemented optimally.Based on the three informants' answers, it can be concluded that the PKU Muhammadiyah Bantul Hospital has a discharge summary. The types of medical resumes available are manual and electronic, for electronic a discharge summary can be found on the hospital electronic medical records. A manual discharge summary is given to the patient upon discharge after the patient has been hospitalized.B.Requirements for User Interface ElementsFor data elements for the patient discharge summary user interface adjusts to the manual medical resume but with additions in several sections according to user needs. The addition referred to is the addition of SOAP (subject, object, assessment, planning), an ICD code for each disease diagnosis, procedure, and therapy. C.Redesign discharge summary.PKU Muhammadiyah Bantul Hospital allows the creation of a web-based patient discharge summary portal. It can improve patient information. However, there are several considerations to make the portal design easy for users to understand, such as not clicking too many clicks and being applied on the web.er interface design1)User interface discharge summary logoFig. 2.Logo discharge summary portalThe discharge summary portal interface uses the PKU Muhammadiyah Bantul Hospital logo as an icon for the application. this logo indicated the apps have been installed. Patients will get a website link from the PKU Muhammadiyah Bantul hospital admin for download.Fig. 3.Log in screenThe main page is completed simply. To get a user ID, patients are required to register first on the register menu (Fig.4).Fig. 4.Main pageThe main page designed is simple. To get a user ID,patients are required to register first on the register menu.There is a settings menu to make changes to data, appearance,profile photos, and passwords. This portal available page for patient account (Fig. 5)Fig. 5.Screen of patient account2)Dashbord pageOn the dashboard page, there is an “admin help” menuwhich contains the hospital admin's phone number if thepatient needs it to obtain data or information related to hisdischarge summary. However, there is a chat menu with theadmin which is directly listed in the upper right corner next to the “my account” menu. Patients can directly ask for anythingrelated to their medical resume information to the hospitaladmin. Patients can also send pictures as attachments if needed. With the admin chat menu, it will be easier for patients to exchange information with the admin. However, if the patient experiences network or signal problems, the patient can open the admin help menu which lists the hospital admin's phone number (Fig. 6 and 7). Fig. 6.Admin help menuFig. 7.Chat screen3)Discharge summary patient dataThis portal has a veranda menu as a form of welcome using Arabic and brief information related to a discharge summary (Fig. 8)Fig. 8.Beranda menu4)Personal informationWhen the patient presses the patient personal data menu, the patient will be shown in the next three menus, namely; patient personal data, allergy history, and other information. Of course the information contained in this patient's personal data has been integrated with the data contained in the PKU Muhammadiyah Bantul Hospital. Even though this menu is the patient's personal data, the patient cannot change the contents of the data contained therein by themselves. If there is data that is not suitable, the patient can reconfirm it to the hospital admin (Fig.9).Fig. 9.Personal data5)Patient InformationThe dashboard display about patient information. Patients can see their health information that has been integrated with patient data listed in the PKU Muhammadiyah Bantul hospital information system consisting of vital sign information, admission complaints, diagnosis, therapy, treatment, and discharge conditions (Fig, 10- Fig. 18).Fig. 10.Dashboard patient informationFig. 11.Vital signthe doctor fills in the patient's vital signs during admission and after treatmentFig. 12.ill-condition and historyPatients can access medical history and medication as a means of communication when visiting other hospitals. This portal also provides diagnostic information, of course this provides information on the history of the disease with coding diagnosis using ICD-10 (Fig.13)Fig. 13.Item diagnosisPatients can access information on actions or treatments that have been received during treatment, by pressing the therapy and action menu (Fig. 14). other information the patient can access drugs that have been prescribed by the doctor (Fig. 15)Fig. 14.Therapy and action menuFig. 15.Medical prescriptionIf the patient chooses the home state menu, the patient willknow the situation when he goes home according to theinformation given by the hospital (Fig. 16)Fig. 16.SituationIf the patient selects the SOAP menu, the patient will seethe treatment report data when the patient is admitted to thehospital. The data is filled in by the doctor after examining thepatient when the patient is treated (Fig.17)Fig. 17.SOAP menuTo support the patient's healing process, this portalprovides a prayer menu for the purpose of supporting spiritualhealing (Fig.18)Fig. 18.Pray menuIV.D ISCUSSIONA.Identify the discharge summaryThe use of discharge summaries is still prioritized by manual over electronic. Electronic discharge summary can only be accessed by nurses and doctors in some polyclinics with limited data elements. A discharge summary is given to the patient on discharge. A Manual discharge summary will slow down service if the patient wants to access their health information, while the electronic one makes it easy for patients to access data at any time(1). The web-based discharge summary portal uses a link that is integrated with the hospital information system. A website is a specific computer location on the internet with a unique address called a URL (uniform resource locator), which consists of several linked web pages, which can contain text, images, sound, or video . Users can use the website via computer or mobile (2)(3).Discharge summary also serves as a communication medium for health workers so that health workers know patient health information in an integrated manner between related units(4)(5). Communication is the center of interest or center of interest in situations of human behavior, to divert a message to the recipient with the aim of influencing certain behaviors and actions (6)(7).B.Requirements for User Interface ElementsOne of the most important factors in the preparation of the interface discharge summary, of course, the needs of users who refer to the data in the medical record are found at PKU Muhammadiyah Bantul Hospital. In terms of the user interface, there are several problems such as inconsistent design, lack of prevention and handling of problems, not achieving the ease of users in obtaining the information needed, and not achieving simplicity in visual design(8)(9).The screen user interface design and the colors used in the menu and sub-menu Portal discharge summary is made simpler so that users are interested in the operating system(10)(11). C.Design interfaceDischarge summary design is made by maximizing data elements that remain complete and is expected to make users easy to understand and comfortable in use. Simple steps and an attractive design are also one of the attractions for users to feel comfortable operating a web-based patient medical resume portal. The importance of a design by following the user needed.The purpose of the user interface design is to make it easier for users to work with computers so that they become more productive and enjoyable and effective as possible(12)(13)V.C ONCLUSIONSThe web-based patient discharge summary portal at PKU Muhammadiyah Bantul Hospital can increase the speed of service to patients who want their health information.A CKNOWLEDGMENTOur gratitude goes to all health practitioners, doctors and medical record officers at PKU Muhammadiyah Bantul Yogyakarta, Medical Records and Department of Clinical Information System, Faculty of Health Universitas Jenderal Achmad Yani Yogaykarta.R EFERENCES[1]Awasighe Francis E, Veronica Chizoba G, Adesola O. Using MobileTechnology to Access Sexual and Reproductive Health Information and Services by Adolescent & Young Persons: Findings from Nigeria.Univers J Public Heal. 2019;7(2):73–81.[2]Vest JR, Kern LM, Silver MD, Kaushal R. The potential forcommunity-based health information exchange systems to reduce hospital readmissions. 2014;1–6.[3]Setyorini T. Pengembangan Prototipe Sistem Informasi ManajemenIndustri Rumah Tangga Pangan Berbasis Web Untuk Meningkatkan Pengawasan Keamanan Pangan Di Daerah Istimewa Yogyakarta.2007;[4]World Health Organization. Electronic Health Record Manual forDeveloping Countries. Geneva; 2006. 1–78 p.[5]Mehta RL, Baxendale B, Roth K, Caswell V, Le Jeune I, Hawkins J, etal. Assessing the impact of the introduction of an electronic hospital discharge system on the completeness and timeliness of discharge communication: A before and after study. BMC Health Serv Res.2017;17(1):1–10.[6]Sharda P, Das AK, Patel VL. Specifying design criteria for electronicmedical record interface using cognitive framework. AMIA Annu Symp Proc. 2003;594–8.[7]Lehnbom EC, Raban MZ, Walter SR, Richardson K, Westbrook JI. Doelectronic discharge summaries contain more complete medication informa tion ? A retrospective analysis of paper versus electronic discharge summaries. 2014;43(3).[8]Ong P, Gambatese M, Begier E, Zimmerman R, Soto A, Madsen A.Effect of cause-of-death training on agreement between hospital discharge diagnoses and cause of death reported, inpatient hospital deaths, New York city, 2008-2010. Prev Chronic Dis. 2015;12(1). [9]Kuqi K, Eveleigh T, Holzer T, Sarkani S, Levin JE, Crowley RS.Design of electronic medical record user interfaces: A matrix-based method for improving usability. J Healthc Eng. 2013;4(3):427–51. [10]Elgendi M, Howard N, Lovell N, Hons BE. A Six-Step Framework onBiomedical Signal Analysis for Tackling Noncommunicable Diseases : Current and Future Perspectives Corresponding Author : 2016;1:1–15.[11]Systems CD. Clinical Decision-Support Systems. :698–736.[12]Saitwal H, Feng X, Walji M, Patel V, Zhang J. Assessing performanceof an Electronic Health Record (EHR) using Cognitive Task Analysis.Int J Med Inform [Internet]. 2010;79(7):501–6. Available from: /10.1016/j.ijmedinf.2010.04.001[13]Schnall R, Rojas M, Bakken S, Iii WB, Carballo- A, Carry M, et al. Auser-centered model for designing consumer mobile health application (apps). J Biomed Inf. 2017;60:243–51.。
健康险信息系统平台业务需求说明书V1.1
健康险信息系统平台业务模块需求说明书版本历史本需求文档确认页目录1引言 (7)1。
1编写目的 (7)1.2目标 (7)1.3参考资料 (7)2 数据流与网络架构 (7)2。
1 数据流 (7)2.2网络架构 (8)3 功能需求描述 (9)3。
1理赔信息查询 (9)3。
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1功能概述 (9)3。
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2参考界面 (10)3.2参保人员信息查询 (10)3。
2.1功能概述 (10)3。
2.2参考界面 (10)3.3承保信息查询 (11)3。
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1功能概述 (11)3。
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2参考界面 (11)3.4批量信息查询 (11)3。
4.1功能概述 (11)3。
4.2参考界面 (11)3。
5 统计报表 (12)3。
5.1功能概述 (12)3。
5.2相关定义 (14)3.5.3参考界面 (14)3.6商业健康险即时赔付 (14)3。
6.1功能概述 (14)3.6。
2流程说明 (14)3。
6。
3参考界面 (14)1引言1。
1编写目的1.为明确用户需求、安排项目规划与进度、组织软件开发与测试,撰写本文档。
2。
本文档可供项目经理、设计人员、开发人员、测试人员参考。
1。
2目标按照健康险信息系统平台建设方案，实现三阶段目标。
第一阶段：实现各保险公司与其承保的大病统筹地区基本医保对接,各公司大病保险理赔数据定期传送到行业健康险信息平台(简称平台）,建设全区大病保险理赔信息数据库,实现全区大病保险理赔信息的共享。
具体功能实现理赔、核保查询分析,业务统计分析.第二阶段：获取各统筹地区基本医保数据，定期传送到行业健康险信息平台；定期传送各公司商业健康险理赔数据，建立全区城乡居民健康保险大数据库,实现健康保险数据共享。
第三阶段:实现广西区内商业健康保险的即时赔付。
借助基本医保信息和资金通道，建设“医院业务系统—基本医保系统-广西健康保险信息平台—各公司健康险系统”的业务数据传输路径，实现广西区内商业健康保险的即时赔付。
1.3参考资料1.广西健康险信息平台建设方案.doc2。
全民健康信息平台综合运维管理项目采购需求(用户需求书)
全民健康信息平台综合运维管理项目采购需求（用户需求书）第X部分服务内容及服务要求一、招标要求1、项目名称：XX省全民健康信息平台综合运维管理项目。
2、服务期：自合同签订之日起12个月内。
3、实施地点：采购人指定地点。
二．项目目标紧密围绕20**年卫生健康工作重点，结合疫情时代下的信息化建设问题，进一步完善各级平台建设，加强重要业务系统建设和应用推广，夯实已建设未完全使用的应用系统，通过加大培训力度、优化系统功能等方式，促使应用，提高信息化应用水平；强化基层卫生信息化工作，结合最新的健康扶贫、公共卫生服务、家庭医生签约、绩效考核等政策要求，不断完善基层医疗机构管理信息系统的功能优化，提升应用体验和管理功能；切实提高各级平台数据质量，强化信息标准和网络与信息安全，为深化医改、健康XX及卫生健康事业发展提供信息技术支撑。
三、项目原则“保重点、保基础、促发展”原则，即：保证省平台重点业务业务系统正常运行；保证省平台基础运维、数据互联互通、平台对接、VPN设备运维、健康XXX 公众服务号运维及优化等基础性运维开展；促进互联网+医疗健康便民惠民和县域远程医疗服务等重大事项贯彻落实。
四、项目范围20**年信息化项目涉及省卫健委大部分业务处室、直属单位，其中：基省市县数据互联互通涉及省、市、县、乡、村各级医疗机构基层卫生机构等。
五、项目内容（一）XX省全民健康信息平台的运行维护及数据互联互通工作1、服务目标（1）XX省全民健康信息平台相关的主机设备、操作系统、数据库和存储设备的运行维护服务，保证用户现有的平台及各个业务系统的正常运行，降低整体管理成本。
提高平台及业务系统的整体服务水平。
（2）根据日常维护的数据和记录，提供整体建设规划和建议，更好的为用户的信息化发展提供有力的保障。
（3）省平台的组成主要可分为两类：硬件设备和软件系统。
硬件设备包括网络设备、安全设备、主机设备、存储设备等；软件设备可分为操作系统软件、典型应用软件、业务应用软件等。
【产品管理】医疗保险系统产品需求规格说明书(DOC 69页)
【产品管理】医疗保险系统产品需求规格说明书(DOC 69页)部门： xxx时间： xxx整理范文，仅供参考，可下载自行编辑和安医院信息系统---医疗保险系统V4.5产品需求规格说明书安徽和安科技股份有限公司版权所有，保留所有权利2011年07月23日版本历史目录0.文档介绍 (6)0.1.文档目的 (6)0.2.文档范围 (6)0.3.读者对象 (6)0.4.参考文档 (6)0.5.术语与缩写解释 (6)1.产品介绍 (7)1.1.产品定义 (7)1.2.开发背景 (8)2.产品面向的用户群体 (10)3.产品应当遵循的标准或规范 (11)4.产品范围 (12)4.1.适用领域 (12)4.2.产品内容 (12)5.产品中的角色及用例 (12)5.1.医保办工作人员用例图 (12)6.业务说明 (13)6.1.流程图 (13)7.产品的功能性需求 (13)7.0.功能性需求分类 (13)7.0.1.功能图 (13)7.0.2.功能性需求分类 (14)7.1.数据维护 (14)7.1.1.字典维护 (14)7.1.2.项目对照 (18)7.1.3.院内算法维护 (20)7.1.4.特殊病人维护 (24)7.1.5.批量数据更新 (26)7.1.6.医疗保险工具 (28)7.2.业务操作 (34)7.2.1.门诊报补业务 (36)7.2.2.住院报补业务 (38)7.2.3.病人报补信息维护 (40)7.2.4.居民费用明细传送 (42)7.2.5.病人结算单 (44)7.3.查询统计 (47)7.3.1.病人查询 (47)7.3.2.药品统计 (51)7.3.3.病种人数统计 (54)7.3.4.门诊业务报表 (56)7.3.5.住院医保结算申请表 (58)7.3.6.住院医保结算汇总表 (60)8.产品的非功能性需求 (67)8.1.用户界面需求 (67)8.2.软硬件环境需求 (67)8.2.1.各工作站 (67)8.2.2.数据库 (67)8.3.产品质量需求 (68)8.4.产品性能 (68)0.1. 文档目的把软件的总体功能和性能的概念描述为具体的软件需求规格说明，奠定软件开发的基础。
医疗保险管理系统业务需求说明书
医疗保险管理系统业务需求说明书医疗保险管理系统业务需求说明书医疗保险的基本运作过程是：①医保中心为参保单位／人员建档，并确定应缴费金额。
②医保中心为参保人员建立个人帐户并发医保卡。
③参保单位或人员定期（按月）到医保中心缴费，所缴费用按一定比例划入统筹帐户及个人帐户。
④对未缴费或欠缴单位／人员，医保中心发出催缴通知。
⑤参保人员持医保卡到指定医院门诊看病，费用由个人帐户支付，超支自理。
⑥参保人员到指定医院住院治疗，费用按统筹基金支付，同时个人也要负担一定比例。
统筹基金支付实行起付标准、分段计算、累加支付的办法。
⑦医保中心与定点医院／药房结算费用，交换数据（如黑名单等）。
⑧凡参加基本医疗保险，按时足额缴纳基本医疗保险费的，方可享受医疗保险待遇。
１）医保中心管理子系统供医疗保险管理机构使用，主要实现投保单位和投保职工管理、基金管理（统筹基金和个人账户资金）、结算、黑名单管理、查询、统计、报表输出、审核、系统维护等功能。
２）医保卡管理子系统供医疗保险管理机构发卡使用，主要实现医疗卡注册、年度初始化等功能。
３）定点医院管理子系统供定点医院使用，主要实现处方审核与录入、就诊费用结算、系统查询与维护等功能。
本实验的总控系统只实现第一个子系统，其他两个子系统，读者如感兴趣，请自己分析实现。
下面介绍第一个系统的具体需求：1.征缴业务征缴业务是医保经办机构的核心业务之一，它是依据国家医疗保险征缴政策对参保单位和职工缴纳保费所开展的业务。
1.1 档案管理员工表完成参保单位档案的新建，变更维护，注销等功能，建立参保单位档案后，根据单位提供的职工列表，完成参保个人基本档案的新建，变更维护，注销等功能。
建立个人基本档案后，办理一个医疗证卡用于标识身份（主键），同时为每个参保职工建立一个个人帐户。
1.2 征缴计划每月生成所有参保单位应缴金额（注意职工的某些异动直接影响征缴计划）。
征缴标准如下：◆基础数据月社会平均工资(X)（上级提供）【函数，存储过程？？】职工月工资(Y)（职工基本信息中含有，参保单位提供）◆缴费基数:每个参保职工缴费基数(Z)：YY>X*300% Z= X*300%X*60%<y< bdsfid="96" x*300%="" z="Y</p"></y<>最后参保单位缴费金额（M）：全体职工Z的总和*9%1.3 收款处理收取现金做交费处理，打印现金收据。
体质健康测试信息管理平台产品说明书
河南鼎慧信网络技术有限公司2017-09体质健康测试信息管理平台产品说明书目录1.平台概述 (2)1.1.建设背景 (2)1.1.1.政策依据 (2)1.1.2.国内建设情况 (3)1.1.3.建设的必要性 (3)1.2.建设依据 (4)1.3.已完成的建设目标 (4)2.平台结构 (5)2.1.平台结构框架 (5)2.2.平台应用框架 (6)3.平台内容及功能介绍 (6)3.1.基本资料管理 (6)3.2.成绩管理 (7)3.3.数据交换 (9)3.4.辅助功能 (9)3.5.数据分析 (9)3.6.学生体质健康成绩查询 (9)1.平台概述1.1. 建设背景1.1.1.政策依据为贯彻党的十八届三中全会精神，认真落实教育规划纲要和《国务院办公厅转发教育部等部门关于进一步加强学校体育工作若干意见的通知》（国办发〔2012〕53号）的有关要求，教育部制定印发《学生体质健康监测评价办法》《中小学校体育工作评估办法》《学校体育工作年度报告办法》并印发给各省、自治区、直辖市教育厅（教委），新疆生产建设兵团教育局。
并提出如下要求：一、各地要将学生体质健康监测评价纳入教育现代化指标体系，作为考试制度建设和改革的重要内容，逐步形成科学规范、导向明确、诚信可靠、保障有力的学生体质健康监测评价制度。
要加大经费投入力度。
要将组织开展体质健康测试计入教师工作量。
要加强测试场地、设施和器材等条件建设。
要加强相关技术培训。
二、各地要将学校体育工作评估作为监测教育发展和考核学校工作的重要途径纳入教育督导检查计划，并建立学校体育工作专项督导制度和重点地区学校体育工作挂牌督导制度。
要认真总结学校体育工作经验，及时发现问题，不断改进工作。
三、各地要把学校体育工作年度报告作为一项基本工作制度，通过年度报告全面、客观、真实地反映本地区学校体育工作和学生体质健康状况，系统总结、发现各地的经验和典型，深入分析、研究存在的问题与困难，及时发布年度报告，促进信息公开、共享，推动改革成果转化和深度开发利用，推动学校体育健康发展。
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健康险信息系统平台业务需求说明书V
. 健康险信息系统平台业务模块需求说明书文件状态：[√] 草稿[ ] 正式发布[ ] 正在修改文件标识：
当前版本：
作者：
完成日期：
XXXX年龄、工作单位、固定电话、移动电话、居住地址、医保号、社保机构、门诊次数、住院次数、参保状态、总医疗费、总合规医疗费用、新农合/社保补偿金额、自费金额、大病保险赔款金额(10) 参保人信息查询（注：
与需求3.2重复，请讨论取舍）输入条件：
参保人姓名、参保人身份证号、参保人医保号（三个条件必须录入，且查询时候做校验判断，信息不一致无法查询）返回信息：身份类别、性别、民族、出生日期、证件号、工作单位、居住地、移动电话、固定电话、人员状态、人员属性、医保类型、合同号、保费、保额、参保状态、银行名称、银行帐号（11）参保人补偿信息查询输入条件：
输入条件：
参保人姓名、参保人身份证号、参保人医保号（三个条件必须录入，且查询时候做校验判断，信息不一致无法查询）返回信息：身份类别、证件号、性别、出生日期、工作单位、行业性质、医保号、社保机构、门诊次数、住院次数、参保状态、框架协议名称、
居住地址、固定电话、移动电话、客户说明、输出（补偿历史）、序号、立案号、出险人姓名、出险日期、出险原因、新农合/社保补偿金额、自费金额、大病保险赔款金额、结案时间3.5.2相关定义统计区间：
****年**月**日-开始时间（必填）、结束时间（必填）、市级或县级机构（必填）、公司名称（必填）返回信息：
统筹单位、承保人数（人）、应收保费（元）、实收保费（元）、大病支付人数、大病支付人次、实际医疗费总金额、新农合/社保常规支付总金额、合规医疗费用总额、自费金额、大病赔款金额、大病资金使用率（7）大病保险各医院业务情况统计表输入条件：
医院名称（必填）、医院编码（必填）、开始时间（必填）、结束时间（必填）、就诊类型（非必填）、疾病名称（非必填）返回信息：
序号（系统自动生成）、医院、即时补偿人数、就诊类型、疾病名称、医疗费总额、合规医疗费用总额、新农合/社保补偿金额、自费金额、大病保险补偿金额、已发生垫付额、已结算额、待结算额（8）疾病赔付情况统计报表输入条件：
开始时间（必填）、结束时间（必填）、市级机构（非必填）、县级机构（非必填）、疾病名称（非必填）返回信息：
序号（系统自动生成）、市、县/区、参保总人数、疾病名称、已补偿人数、已补偿金额、补偿比例（9）大病保险补偿前10位情况表(对大病保险补偿额前10位已经补偿结案的案件进行查询)输入条
开始时间（必填）、结束时间（必填）、市级或县级机构（必填）、公司名称（必填）返回信息：
身份类别、证件号、性别、出生日期、年龄、工作单位、固定电话、移动电话、居住地址、医保号、社保机构、门诊次数、住院次数、参保状态、总医疗费、总合规医疗费用、新农合/社保补偿金额、自费金额、大病保险赔款金额(10) 参保人信息查询（注：与需求3.2重复，请讨论取舍）输入条件：
参保人姓名、参保人身份证号、参保人医保号（三个条件必须录入，且查询时候做校验判断，信息不一致无法查询）返回信息：身份类别、性别、民族、出生日期、证件号、工作单位、居住地、移动电话、固定电话、人员状态、人员属性、医保类型、合同号、保费、保额、参保状态、银行名称、银行帐号（11）参保人补偿信息查询输入条件：
输入条件：
参保人姓名、参保人身份证号、参保人医保号（三个条件必须录入，且查询时候做校验判断，信息不一致无法查询）返回信息：身份类别、证件号、性别、出生日期、工作单位、行业性质、医保号、社保机构、门诊次数、住院次数、参保状态、框架协议名称、居住地址、固定电话、移动电话、客户说明、输出（补偿历史）、序号、立案号、出险人姓名、出险日期、出险原因、新农合/社保补偿金额、自费金额、大病保险赔款金额、结案时间3.5.2相关定义统计
****年**月**日：可选择统计新农合还是社保统筹单位：
可选新农合、社保各统筹单位，如**农合办、**卫生局应收保费=承保人数*实际中标协议价（元）实收保费=实际到账的保费大病支付人数：
同一人，统计区间内，N次理赔记为1人大病支付人次：
同一人，统计区间内，N次理赔记为N人次合规医疗费用=医疗总费用-新农合/社保补偿费用-扣减医疗费用（不报销部分）大病资金使用率=大病支付总金额/应收保费3.5.3参考界面无3.6商业健康险即时赔付（第三阶段）3.6.1功能概述在广西区内实现商业健康险即时赔付功能，客户在医院端完成一站式结算。
3.6.2流程说明在完成第
一、二阶段目标的基础上，进一步讨论相关业务处理流程。
3.6.3参考界面无达到当天最大量API KEY 超过次数限制。