Looking at the achievements and future development of the National Smart Medical Insurance Laboratory from a multi-dimensional perspective​

Text | Jiang Jianguo Chongqing Medical Security Bureau

With the convergence and integration of information technology and human production and life, the rapid popularization of the Internet, global data showing explosive growth and massive agglomeration, have had a significant impact on economic development, social governance, national management, and people's lives.

Laboratory construction background

General Secretary Xi Jinping pointed out that there is no modernization without informatization.

Laboratory positioning

The laboratory always adheres to the responsibility of "serving the overall situation in one domain", and better supports and serves the responsibility of the efficient construction of national medical insurance informatization, closely following the dual function positioning of "information center and experimental environment", and mainly undertakes medical insurance informatization test verification, operation and maintenance Services, smart medical insurance innovation management, etc.

1.

As a national medical insurance informatization talent training base, the laboratory has established a comprehensive talent life-cycle management training mechanism with equal emphasis on medical insurance business, technology and management, built a talent training ability platform, and provided cadres in the national medical insurance system with comprehensive informatization basic knowledge and Advanced information technology application and other capacity-building trainings provide comprehensive capacity training for national medical insurance informatization talents; explore the establishment of flexible, diversified, independent and controllable construction operation and maintenance teams, and control project management and participate in development operation and maintenance during project implementation , Clarify technical standards and other core links, accelerate the improvement of the professional quality of medical insurance informatization talents, promote the medical insurance informatization team to deepen the understanding of the development of medical insurance informatization under the new technical framework, and explore solutions for the national medical insurance departments to solve the shortage of medical insurance informatization talents Practical experience, as well as standardized and scientific project management experience.

2.

Through the construction of the national smart medical insurance experimental cloud platform, it provides the National Medical Insurance Bureau and various provinces and cities with the basis for related new technology innovation, platform adaptation, business system testing, data migration testing, new business innovation, disaster preparedness drills, and remote settlement test verification.

Three, innovation achievement conversion experiment

The office will explore the application of new technologies in smart medical insurance, gather medical insurance policies, AI applications, big data governance and other fields, focus on centralized procurement of drugs and medical consumables, DRG payment methods, drug traceability, electronic bills, medical insurance anti-fraud and other medical insurance Reform direction, carry out research, achievement transformation and promotion demonstration related to smart medical insurance, and continuously enrich the connotation of smart medical insurance.

Current construction situation

The laboratory has been included in the work report of the Chongqing Municipal Government in 2021 and the city’s "14th Five-Year Plan" for high-level advancement.

First, the core area of ​​the experimental platform, the public service area, and the innovation adaptation area were fully completed and put into use.

The second is to complete the construction of basic support facilities and locate the Mercury Science and Technology Building in Liangjiang New District, Chongqing.

The third is that the laboratory has gradually played its role as a national medical insurance informatization talent training base, focusing on the needs of national medical insurance informatization construction, and integrating high-quality training resources such as IT governance, information security, network construction, and big data in universities and information companies.

1.

Establish the laboratory organization structure, compile and publish the "Laboratory Function Settings, Internal Departments and Staffing Plan", and further refine the organizational structure and management personnel.

2.

Platform architecture.

1.
Platform architecture.
In accordance with the relevant constraints and requirements of the National Medical Security Information Platform Construction Guidelines, the laboratory experimental platform verifies the national medical insurance business subsystems and middle-level services in accordance with the principles of platform development and design, and relies on the national unified technical system and architecture to provide the platform for the National Medical Insurance Administration The development, testing and pre-release environment provide a suitable verification environment for the expansion of subsystems, middleware, databases, big data and cloud platforms in various provinces.

2.
Platform construction content.
The laboratory will serve as an important testing and verification environment for the construction of national medical insurance informatization.
A national medical insurance testing area and a medical insurance application innovation adaptation area will be built in the National Smart Medical Insurance Experimental Cloud Computing Center.
The national medical insurance testing area will be a reduced version of the National Medical Insurance Bureau data center.
Functionally, it is constructed to meet the national platform's 1:1 functional verification test requirements, and its performance is constructed based on the performance verification test requirements of 50 million insured users, providing a basic support environment for the development, testing and pre-release of the national medical insurance platform application system.
.
The medical insurance innovation adaptation zone provides middleware, database, big data and data migration testing and verification environment for medical insurance applications in various provinces and cities.

3.
Platform construction situation.
The construction of the cloud resource infrastructure of the experimental platform has been fully completed, and the National Medical Insurance Bureau has officially undertaken the testing and development of environmental resource requirements.
In terms of scale, 47 high-density cabinets and more than 200 servers provide computing power support for the experimental platform.
In terms of network, the spineleaf structure is used to manage and configure the entire network at the same time combined with VxLAN+SDN technology.
Through the e-government extranet and medical insurance dedicated line, the interconnection with the national platform is fully realized.
In terms of security, the network is divided into domains according to the requirements of Equal Security 2.
0, and data security is guaranteed by building systems such as data desensitization, data leakage prevention, and database auditing.
The testing and development of environmental resources cover the comprehensive medical insurance business, service terminal management platform, report center, electronic prescription center, electronic voucher center, risk control center, fund operation and audit supervision subsystem of the National Medical Insurance Administration of the National Medical Insurance Administration, and the management subsystem of cross-provincial medical treatment , Internal control subsystem, internal unified portal subsystem, unified certification center, drug and medical consumable recruitment management subsystem, medical insurance business basic subsystem, medical insurance business integrated service terminal management platform, medical security intelligent supervision subsystem, mobile payment center , Operation monitoring subsystem, policy center and more than 50 subsystems.

3.
Transformation and construction of innovation achievements

Relying on the laboratory, we will jointly build the Chongqing Smart Medical Insurance Research Center with Chongqing University to promote the integration of "production, study, research and application".
The medical insurance information system service status monitoring and safety prevention and control system, the application research of the medical insurance big data capability open system, and the application model of blockchain in the "three-medicine linkage" reform have achieved theoretical results.
Keeping close to the strategic opportunities for the construction of the Chengdu-Chongqing twin-city economic circle and the comparative advantages of Chongqing's construction of a "smart city", adhere to the concept of openness and sharing, give full play to the experimental role of the laboratory platform, and first explore blockchain + electronic bills, 5G, and medical insurance big data analysis Application and demonstration application of smart medical insurance at the grassroots level.
Relying on the resources of Chongqing Kunpeng Computing Ecological Center and other bases, it provides an experimental environment for the safe, reliable and sustainable development of medical insurance informatization.
It is the first in the country to develop Encore engineering, artificial intelligence, and artificial intelligence based on the full chain of domestic servers, cloud services, chips and network security.
Test the application of new technologies such as 5G and blockchain, create a leading demonstration of national medical insurance information and business collaborative innovation, and strive to build a leading application demonstration highland for smart medical insurance innovation.

Thinking about the future development direction of laboratory

1.
Lay the cornerstone of smart medical insurance development with standards and norms

The high-quality development of smart medical insurance is not only a simple change from manual operation to system implementation, nor is it traditional data-based analysis and statistics, but more about the pursuit of qualitative development and intelligent enhancement.
It can be said that breakthroughs are made to solve the "shortcomings", "weaknesses", "contradictions" and "intelligence" in the construction of smart medical insurance, so as to promote the high-quality development of smart medical insurance.
Combining the actual needs of medical insurance informatization construction, starting from the top-level design, build a standard and standardized indicator system, policy system and other tool systems, draw up a blueprint for smart medical insurance construction, and promote the development of business led by informatization.

Therefore, the laboratory is positioned as a smart medical insurance innovation research center.
First, it is necessary to accurately define and interpret the connotation of smart medical insurance, clarify the smart medical insurance index evaluation system, the smart medical insurance construction path, etc.
, and combine the evaluation index system to provide evaluation reference coordinates for the national smart medical insurance construction.
Achieve the goal of promoting construction with evaluation, promoting reform with evaluation, and leading by benchmarking.
The second is to maintain and update various basic codes, standards and specifications in accordance with the overall construction thinking of the construction of national medical insurance informatization.
At the end of 2021, the national medical insurance system will be launched one after another.
The standard specifications and basic codes formed based on the original architecture design will have more or less deviations in actual application.
As an important supporting force for the construction of national medical insurance informatization, laboratories should take the lead.
Undertaking the mission of maintaining and updating its standards, collecting feedback from various provinces and cities during the implementation process, to ensure that the national unified medical insurance "language" and system architecture are closer to the grassroots level, in line with the needs of medical insurance business development.

2.
Empower the development of smart medical insurance with innovative achievements

Since the establishment of the National Medical Insurance Bureau, through anti-cancer drug negotiation, centralized procurement and use, outpatient medication guarantee for "two diseases", and medical insurance catalogue adjustments, the prices of medicines and consumables have been greatly reduced.
While reducing fund expenditures, it has greatly reduced the price of medicines and consumables.
Reduce the medical burden of the masses.
Business areas such as continuous drug purchases, "two diseases" outpatient medication protection, disease-based payment, fund supervision and other business areas require more information technology support and assistance.
The rise of new technologies will lead the development of medical insurance business in the future technological changes with "wisdom" as the core.

After the national medical insurance information platform is launched, the era of smart medical insurance will start a new journey, realizing the transformation from business data to data value.
Starting from the medical insurance business, it is necessary to accurately and comprehensively understand the fund payment situation, the drug circulation situation, and achieve the pre-supervision.
Some IoT technologies are used in the application scenarios of medical treatment, drug purchase, prescription outflow, and medical insurance electronic vouchers.
Smart terminals will continue to enter market.
In order to realize the value of data at the data level, it is necessary to fully understand the characteristics of big data, namely "Volume", "Variety", "Velocity (timeliness)", "Veracity" and "Value".
Great value)".
In view of the characteristics of the 5 Vs, data standards, data collection channels, data exchange frequencies, data quality inspection mechanisms, business data models, etc.
should be established, and various business models should be trained according to business needs, and historical data should be continuously input to form a more pragmatic The business model of the company ultimately realizes the overall empowerment of medical insurance data and promotes the construction of an operating ecosystem for pharmaceutical companies and financial institutions.
At the application level, innovation is bound to focus on the direction of national medical reform.
For example, payment method reform, "two diseases" medication protection, smart management, diversified supervision methods, improvement of public service capabilities, and medical insurance integration applications (Internet +, multi-level medical insurance) under new business formats will become the future of national smart laboratories Key business innovation research direction.

3.
Build a compound talent team based on theory and practice

To achieve the goal of "a game of chess in the whole country" for the construction of national medical insurance informatization, it is necessary to build a team of high-quality new medical insurance informatization talents.
The new type of compound medical insurance informatization talents need to have knowledge of information technology foundation, medical insurance business, new technology theory and so on.
As the national informatization talent training base, the laboratories can focus on the following points for consideration: First, create a unified job standard.
From the dimensions of business, technology, and management, the requirements for medical insurance informatization job capabilities are sliced, and a uniformly granular job capability standard is formulated.
The second is to create a unified competency model.
Based on job responsibilities, clarify the necessary skills for the job to "know the theory and know how to operate", and establish a service capability maturity evaluation model and standard.
The third is to create a unified curriculum system.
Based on the needs of different ability levels and positions, construct a "learning map", set up a unified curriculum system, establish a knowledge park for medical insurance informatization, and capitalize on the experience summary, information technology training, and application system function construction in the construction of medical insurance informatization.
The fourth is to create a unified talent assessment system.
Establish individual and team personnel ability evaluation system, as well as appraisal and rating mechanism.
Explore the establishment of professional technical sequences and technical promotion paths for medical insurance informatization talents.

As the saying goes: "Improve in theory and grow in practice.
" After having a systematic theoretical knowledge training, you still need to exercise in actual work.
Exercise in practice can be considered from the following aspects.
One is to deeply participate in the construction of medical insurance information platforms in various provinces and cities, and continuously improve technical knowledge and practical capabilities in the process of project construction.
The second is to actively encourage comrades engaged in information work to go to agencies and business offices for rotation exercise, so that technical talents can become business experts.
The third is to make full use of the infrastructure resources of the experimental platform to perform practical operations on the installation and configuration of related software and hardware.
And to review the problems in the operation or construction process of various provinces and cities to improve the ability of technical personnel to analyze and solve problems.
The fourth is to strengthen the scientific research on the innovative application of medical insurance, and conduct data collection and data analysis through the scientific research process to improve the level of business.

summary

The construction of national medical insurance informatization is still in stages, and the follow-up long-term stable operation and business development iteration are the lasting tasks of informatization construction.
As the supporting force of the national medical insurance informatization, the laboratory has achieved hard-won stage results.
It embodies the hard work and sweat of everyone's care and support.
It also bears and embodies everyone's deep feelings for informatization to promote the high-quality development of the medical insurance industry.

In general, the functional positioning of the laboratory is gradually clear, and the supporting service role is effectively played, and the laboratory has a lot to do in the future.
However, we should also be soberly aware that there is a long way to go for the laboratory to help meticulous management of medical insurance.
It still needs to continuously improve its own capabilities, implement various tasks, and continue to uphold the original mission of "serving the overall situation in one domain", with high quality and high standards.
Promote the construction of smart medical insurance, improve the efficiency of medical insurance governance, and empower the high-quality and sustainable development of medical insurance.