This project was initiated to ensure that National Health Insurance (NHI) payment and auditing systems are kept up to date with the latest advancements to provide healthcare institutions as well as the general public with diverse services, achieve effective systems integration, and reduce system expenses for NHI. In order to provide the public with medication use safety and satisfy people’s right to know, IISI established a “NHI PharmaCloud System” and “My Health Bank” giving both the general public and physicians access to a great collection of useful information and knowledge.
IISI employed new technology, modular designs, and flexible architecture to satisfy various system requirements of the client to achieve the following objectives:
- Comprehensive medical data system capable of supporting and managing over 20,000 medical institutions throughout the country as well as meeting functional requirements of handling annual disbursements amounting to more than NT$600 billion per year.
- Integrated relevant medical payment systems while combining database features and process workflows to improve system performance and flexibility for accommodating changes.
- Powerful functions provided by the core data exchange module help enhance data sharing between the National Health Insurance Administration (NHIA) and its branch offices as well as external health insurance information websites, ensuring that health insurance information provided is consistent and up-to-date.
- A health insurance data web of the NHIA has been constructed. The data web may be used by contracted medical care institution when declaring medical expenses. The NHIA can also use the data web to deliver various notices and documents to target health institutions or hospitals.
- Training courses for 6,000 attendants totaling more than 28,000 man-hours have been provided, ensuring that users are well versed and familiar with system usage and operations. Routine tasks are tightly integrated with the data system to maximize the resulting benefits.
- The NHI PharmaCloud System offers real-time querying functions to physicians and pharmacists of affiliated medical institutions, allowing them to search recent medication details and records of the insured subject. This would help prevent physicians from issuing repeated prescriptions or medication use, and thus satisfy requirements for medication safety and benefiting the insured, physicians, and the NHI program itself.
- In 2014, the NHI PharmaCloud System compiled statistics from about one-year worth of data. The system had processed a high volume of 12 million querying visits, demonstrating its performance and its ability in meeting the expectations of the NHIA and medical institutions.
- Statistical data of the NHI PharmaCloud System in the first quarter of 2014 showed that average medication expenses and prescription items per person were both reduced since the system became operational. Reduced medication expenses amounted up to NT$300 to 400 million, proving the effectiveness of reducing repeated or wasteful prescriptions.
- Medication usage data and records from My Health Bank enable the general public to check all prescription medication and healthcare treatment received from medical institutions during the past year. Physicians could also use the system to effectively assess and obtain details of medical services received by the subject in other hospitals and clinics, helping them provide accurate medical disposition and prescribe medication that target the appropriate symptoms while improving medication safety and performance.
- My Health Bank also includes information on patient allergic history, helping people manage their own health as well as providing a reference when they seek medical aid from healthcare institutions.
- My Health Bank allows people to understand their own treatment, testing, diagnostics, and medication status in medical institutions, allowing users to perform proper self-management of health and improving overall public healthcare. Such improvements in healthcare information transparency would help reduce wastage of NHI resources.
- Data quantity is huge, so the information system must ensure its high reliability.
There are more than one million man-numbers seeking medical advice in Taiwan every day. The data quantity of necessary recording and operation by the regulations of Law of Health Insurance is amazing. So the information system must keep its high reliability to supply the best service.
- Data exchange among different divisions must ensure high accuracy and instantaneity.
The respective health insurance division normally processes its own responsible information, but should execute data exchange or inquiring when managing information belongs to other divisions. If the information is not instant enough, that will lead to the result of doubting the correctness of the information.
- The operation procedure of the existing information systems for respective division must be standardized.
The respective health insurance division authorized other programmer or itself to write the program, so lead to the result of un-standardized operating systems among different divisions.
- The aspect of medical treatment accounting
- Examining mechanism modularized
Integrate examining of outpatient service, hospital service, and contracted pharmacy and the auxiliary specialized examining of outpatient service, hospital service, and contracted pharmacy, based on examining regulations to analyze, to establish the modular mechanism and cooperate with examining analysis standard formulated by respective business units themselves. The purpose is to examine declaration information of medical treatment payment effectively and rapidly.
- Payment declaration and paying system in flexibility.
Integrate declaration accepting, examining of outpatient service, hospital service, and contracted pharmacy and the auxiliary specialized examining of outpatient service, hospital service, and contracted pharmacy. Adopt the procedure control mechanism of accepting by flexible and module arrangement until the following examining. In order to accommodate changing tried paying plan and achieve the purpose of effectively controlling the medical treatment payment.
- Combine accounting completely
Closely combine medical matters management system, medical treatment payment system, and financial paying operation of medical treatment payment, also cooperate with violation operation and steps examining for medical treatment payment of medical matters management. The purpose is to effectively supervise and control medical treatment payment.
- The aspect of business investigation and control
Lodge business investigation and control in business and project reproduce procedure, focus on nodes possibly appears abnormal business procedure, set the operation examining point from procedure control operation, and regularly cooperate with application system by executed unit to supply related information for examining operation. When abnormal business procedure happens, the system will supply active or passive message for related personnel as an evidence to process the abnormal procedure. Computer will continuously track the abnormal condition of managing at the same time, and supply the abnormal information for related personnel in order to achieve the purpose of investigation and control.
- The aspect of system operating and data exchange
- System development and procedure control in standardization
Cooperate with the operating characteristics (Data quantity is huge and long executing period for batch operating) of Bureau of Health Insurance to establish control information of respective operating procedure and ensure the completeness and correctness of operating by computer to control.
- The procedure of system development in standardization
Through business procedure and project reproduce, introduce a great amount of managing experience of parallel development, in this way, not only reinforce the standardized ability of system development procedure, but also improve the reliability of system maintenance and management in a great scale.
- Promote the controllable degree of system executing environment
All application systems are executing under control of the central management system, besides security, can prevent human's mistake.
- Data exchange in instantaneity
Supply single window for respective external connection interfaces, to accommodate the purpose of regularly exchange data among respective related units, and reinforce the information sharing mechanism among general bureau and its divisions
National Health Insurance Administration, Ministry of Health and Welfare