HL7기반 노인장기요양보험 등급판정시스템 모형 개발

Abstract

Objectives: The purposes of this study were to develop the HL7-based Classification System for the Long Term Care Insurance for the elderly in order to reduce classification errors and to reduce variations in classification among rating doctors. Specifically, the classification system was developed for the elderly who were eligible for the Long Term Care Insurance based on HL7 standards and eligibility criteria developed by the National Health Insurance Cooperative (NHIC). Methods: 38 cases that were actually reviewed by rating committee in May 2009 were selected from the classification data submitted to the long term care insurance unit at the D branch of NHIC on HL7. The system was designed by selecting 46 items from health insurance and NHIC criteria and IPI(Insurance Patient Information) message based on HL7 2.5 in order to transmit messages to other institutes. The system was analyzed and designed by DFD(Data Flow Diagram) and HIPO(Hierarchical Input, Process, Output). The system was evaluated through frequency analysis of system environment and rating data after calculating the 2nd grade by operating each module of HL7 message. Results: The results of this research were as follows: 38 cases submitted by doctors were 22 right cases and 16 wrong cases for the physical condition area; 27 right cases and 11 wrong cases in the area of mental state; and 26 right cases and 12 wrong cases in the area of independence of daily life. The number of cases whose grade was changed was 4: 1 case from 4th grade to 3rd grade, 2 cases from 3rd grade to 2nd grade and 1 case from 2nd grade to 1st grade. The cause of functional disorder for changing grade was 3 dementia and 1 bleeding. Conclusions: The model of the HL7-based Classification System for the Long Term Care Insurance for the elderly was designed to reduce classification errors and to reduce variations in classification among rating doctors. After the use of the model system, its usability was assessed.